Primary Tumor Regression Patterns In Esophageal Squamous Cell Cancer Treated With Definitive Chemoradiotherapy And Implications For Surveillance Schemes

ObjectiveThe current study was to investigate the primary tumor regression patterns of patients with esophageal squamous cell carcinoma(ESCC)treated with definitive chemoradiotherapy(CRT),in order to determine an optimal surveillance scheme.Material and methodsBetween September,2004 and December,2015,the clinical data of patients with ESCC treated with definitive CRT from Fujian Province Cancer Hospital,was reviewed.A total of 82 of these patients met the inclusion criteria and were collected for analysis.The patient's full tumor regression time,progression-free survival,overall survival,failure patterns were analyzed.Data were analyzed using IBM SPSS version 21.0.Actuarial rates and survival curves were produced using the Kaplan-Meier estimator method and compared with the log-rank test.The correlation of tumor regression with clinical characteristics was evaluated using Pearson correlation analysis.P<0.05 was considered to indicate a statistically significant difference.Results(1)At the first surveillance visit date at the end of CRT,a total of 21 patients achieved complete response(early-CR),29 patients reached partial response(PR),25 patients maintained stable disease(SD)and 7 patients encountered progression of disease(PD).During subsequent surveillance,a total of 14 PR patients regressed continuously to CR(later-CR),15 patients maintained PR(early-PR),9 SD patients gradually regressed to PR(later-PR).At full tumor regression(FTR),a total of 21,14,15,9,16 and 7 patients were defined as early-CR,later-CR,early-PR,later-PR,SD and PD,respectively.The median FTR time for later-CR and later-PR was 7.5 weeks and 7 weeks,respectively.Pearson correlation analysis showed that tumor site,N stage and cTNM stage were closely related to tumor regression after CRT(P <0.05).(2)The median follow-up time of the cohort patients was 22 months(range,3-108 months).At the last surveillance visit,a total of 18 patients had survived,62 patients had succumbed to disease progression and 2 had succumbed for unknown reasons.Survival analysis found that the 1,2,3-year OS,LFFS and DFFS of the early-CR group was superior to the later-CR,early-PR,later-PR,SD and PD groups(termed “non-CR”)(P<0.001).There were no significant differences in survival among later-CR,early-PR,later-PR and SD patients(termed “non-early-CR”)(P>0.05).However,non-early-CR patients has significantly improved OS compared with PD patients(P=0.003).(3)Locoregional failure(LF)was the predominant failure pattern in non-CR patients,however,it was the distant metastasis the major failure pattern developed in early-CR patients.There was no significant difference about the median time to failure(MTF)after CRT in early-CR(median time 23.5 months)and non-early-CR patients(median time was only 11 months)owing to the small number of patients in the current study(P>0.05).ConclusionEarly-CR after CRT may serve as a robust prognostic predictor in patients with ESCC treated with CRT.A surveillance visit date ?7 weeks after CRT is recommended as the optimal initial date.The earliest failure in early-CR patients was at least 11 months(range from 11 to 43 months)after CRT completion,suggest that intensive follow-up should be started 11 months after CRT.For non-CR patients who are expected to have poor survival,the subject of surveillance after CRT should be concentrated on symptoms,nutrition and psychosocial support,rather than survival.Due to the limitations of a retrospective,observational study,the current conclusions require further confirmation in clinical settings.