Survival And Risk Factors Of Neoadjuvant Therapy For Locally Advanced Esophageal Squamous Cell Carcinoma

Objective: Retrospectively analyze the clinical efficacy of neoadjuvant therapy in locally advanced esophageal squamous cell carcinoma(ESCC),and explore the influencing factors of neoadjuvant therapy for ESCC.Method:From January 2013 to December 2016,460 cases of advanced esophageal squamous cell carcinoma were diagnosized and treated with radical resection in Department of Thoracic Surgery,The Union Clinical Medical College of Fujian Medical University.Including 351 cases in the operation group and 109 cases in the neoadjuvant treatment group.In the neoadjuvant treatment group,preoperative adjuvant chemoradiotherapy or chemotherapy were performed and followed by the radical resection of esophageal cancer after re-evaluating the tumor status.While in the simple operation group,the radical resection of esophageal cancer was performed after the relevant examination was completed.The radical resection rate,the incidence of complications 30 days after surgery,and the long-term survival of the patients was compared between the simple operation group and the neoadjuvant treatment group.The OS rate was calculated by kaplan-Meier method.The univariate prognostic analysis and Cox model multivariate prognostic analysis was tested by Logrank test in the neoadjuvant treatment group.Results:The radical resection rates of the operation group and the neoadjuvant group were 98.6 %(346/351)Vs 99.1 %(108/109),with no significant difference between the two groups(?2=0.166,p=0.684).The incidence of postoperative pulmonary infection,arrhythmia and anastomotic fistula in the two groups was 27.1%(95/351)Vs 28.4%(31/109)(?2=0.079,p=0.779),7.4%(26/351)Vs 7.6%(9/109)(?2 = 0.085,p = 0.770),14.0%(49/351)Vs 11.9%(13/109)(?2=0.295,p=0.587).respectively,the difference of postoperative complication between the two groups was not statistically significant.The total clinical response rate of neoadjuvant therapy was 33.9%(37/109).The 1-year and 3-year survival rates were 87.6%,62.4% in the simple surgery group,and 89.5%,54.5% in the neoadjuvant treatment group,with no statistically significant difference between the two groups(P=0.358).Univariate analysis showed that the factors influencing OS were age,clinical N staging,clinical TNMstaging,pathological T staging,pathological N staging,pathological TNMstaging,and vascular tumor thrombus(P= 0.022,0.017,0.014,0.025,0.000,0.000,and 0.001).Multivariate analysis showed that pathological T staging and pathological N staging were the independent risk factors affecting OS(P=0.051,0.000).Conclusions:Neoadjuvant therapy did not increase the incidence of postoperative complications,but it did not improve the overall long-term survival of patients with locally advanced esophageal cancer.Just a small number of patients of advanced esophageal squamous cell carcinoma achieved the improving of long-term survival by reducing the clinical staging.A higher objective remission rates was observed in clinical II staging and pre-neoadjuvant lymph node negative status.The application of neoadjuvant therapy in patients with locally advanced esophagus still needs further exploration.