Recurrence risk stratification of esophageal squamous cell carcinoma after neoadjuvant chemoradiotherapy

Objective: To analyze the pattern of recurrence risk and investigate the association between pathological staging and recurrence risk in patients with esophageal squamous cell carcinoma (ESCC) treated with neoadjuvant chemoradiotherapy (CRT). Methods: Clinical data of 174 patients with advanced thoracic ESCC treated with neoadjuvant CRT between 2002 and 2015 were retrospectively analyzed. All patients received preoperative concurrent platinum-based chemotherapy with conformal radiotherapy (40-50.4 Gy, conventional fractionation) combined with surgery. Kaplan-Meier method was utilized to analyze the survival, the log-rank test was conducted to compare the differences between groups, and the Cox regression model was used for multivariate analysis. Results: The median follow-up time was 53.9 months. A total of 44.8% of patients achieved pathological complete response, and 59 patients (33.9%) recurred after neoadjuvent CRT. The postoperative recurrence rate was 22.2% for patients with pathological stage 0/I, 38.7% for stage II and 68.2% for stage III (P = 0.000). The 5- year recurrence-free survival (RFS) rates were 74.7%, 61.4% and 20.9% for patients with pathological stage 0/I, II and III, respectively (P = 0.000). In total, 20.5% of patients with pathological stage 0/I or II recurred after postoperative 3 years, whereas all patients with pathological stage III recurred within postoperative 2 years. Multivariate analysis demonstrated that age, clinical TNM staging, chemotherapy regimen, and pathological response after CRT were independent prognostic factors affecting the RFS (P = 0.027, 0.047, 0.010, 0.005). Conclusions: Pathological stage is significantly correlated with the recurrence risk in ESCC patients after neoadjuvant CRT. Risk-based surveillance strategies can be defined according to different pathologial staging. (authors)