Analysis On Influencing Factors On The Short-term Efficacy Of Neoadjuvant Chemotherapy For Advanced Esophageal Squamous Cell Carcinoma

Objective:To understand the influencing factors on the short-term efficacy of neoadjuvant chemotherapy for advanced esophageal squamous cell carcinoma,so as to serve the preoperative adjuvant treatment for esophageal squamous cell carcinoma.Methods:The clinical data of 115 patients with esophageal cancer who underwent neoadjuvant chemotherapy(docetaxel+nedaplatin)in the Department of Thoracic Surgery,Affiliated Hospital of North Sichuan Medical College from February 2016 to August 2020 were analyzed retrospectively.According to the WHO criteria for efficacy assessment of solid tumors,tumors were divided into complete remission(CR),partial remission(PR),stable disease(SD)and progressive disease(PD).CR and PR were defined as effective chemotherapy,SD and PD were defined as ineffective chemotherapy.Univariate and multivariate analysis were used to analyze the influencing factors on the short-term efficacy of neoadjuvant chemotherapy.Use R software to establish a nomogram model for predicting the recent clinical remission of advanced esophageal squamous cell carcinoma with neoadjuvant chemotherapy,use Bootstrap method for internal verification of the model,use C-index(C-index),calibration curve and receiver operating characteristics The(ROC)curve evaluates the predictive performance of the nomogram.Results:After 115 patients underwent(docetaxel+nedaplatin)neoadjuvant chemotherapy for 2 cycles,there were 9 patients with complete remission(CR),56 patients with partial remission(PR),43 patients with stable disease(SD)and 7 patients with progressive disease(PD).Among them,chemotherapy was effective(CR+PR)in 65 cases and ineffective(SD+PD)in 50 cases,with the clinical effective rate of about 56.52%(65/115).Among 65 cases in the effective chemotherapy group,59 cases underwent surgery,and the R0 surgical resection rate was 84.7%(50/59).Only 30 cases in chemotherapy ineffective group underwent surgery,and the R0 resection rate was 63.3%(19/30).There was significant difference in R0 resection rate between the two groups(P<0.01).Univariate analysis showed that there were significant differences in smoking history,alcoholism history,tumor location,tumor differentiation degree,and cN stage before chemotherapy between the effective neoadjuvant chemotherapy group and the ineffective neoadjuvant chemotherapy group(P<0.05).Logistic regression analysis showed that the degree of tumor differentiation and cN stage before chemotherapy were independent factors affecting the short-term efficacy of neoadjuvant chemotherapy for advanced esophageal squamous cell carcinoma(P<0.05).The C-index and the area under the ROC curve(AUC)of the nomogram are both 0.763(95%CI:0.676-0.850),the calibration curve fits well,and the best critical value of the nomogram is calculated by the Youden index 70.04 points,the sensitivity and specificity of the critical value are 80%and 58%.Conclusion:1.The degree of tumor differentiation and cN stage before chemotherapy are independent influencing factors of the short-term efficacy of neoadjuvant chemotherapy for advanced esophageal squamous cell carcinoma.2.The established clinical prediction model has good discriminationand accuracy,and can provide a reference for individualized analysis of the short-term efficacy of neoadjuvant chemotherapy for advanced esophageal squamous cell carcinoma and screening treatment subjects.