Correlation Between Histopathological Response of Esophageal Squamous Cell Carcinoma to Neoadjuvant DCF Therapy and the Clinical Efficacy of Palliative Chemotherapy for Recurrence.

Abstract

Background: Docetaxel-cisplatin-5-fluorouracil (DCF) is a new standard neoadjuvant therapy for locally advanced esophageal squamous cell carcinoma (ESCC) in Japan. However, some patients experience recurrence and require further systemic platinum-containing chemotherapy. It is unclear whether such regimens are appropriate after a poor histopathological response to neoadjuvant DCF.

Methods: Data were retrospectively collected on patients with recurrence of ESCC treated with palliative chemotherapy after neoadjuvant DCF at our institution between February 2014 and June 2022. We defined patients with a grade 0-1 histopathological response as insufficient responders (IRs) and those with grade 2-3 as good responders (GRs). The correlation between the histopathological response and the response to palliative chemotherapy was investigated.

Results: Thirty-two patients (median age 63.5 years, range 46-76) were included. Performance status was 0 in 12 (37.5%), 1 in 16 (50.0%), and 2 in 4 (12.5%). Histopathological response grades 0/1/2/3 were 3.1%/68.7%/21.9%/6.3%, respectively. Platinum-containing chemotherapy was administered to 13 patients (56.5%) in the IR group and 9 (100%) in the GR group. The overall response rate was 34.8%, and median progression-free survival was 2.431 months in the IR group and 44.4% and 4.041 months, respectively, in the GR group. Multivariate analysis identified a chemotherapy-free interval of < 6 months as an independent prognostic factor (HR 4.096, 95% CI 1.116-15.037) but not the histopathological response (HR 1.137, 95% CI 0.309-4.177).

Conclusions: Histopathological response to neoadjuvant DCF therapy did not affect the efficacy of first-line chemotherapy for recurrent ESCC.