Skip to main content
SpringerLink
Log in

The role of adjuvant chemotherapy in esophageal cancer patients after neoadjuvant chemotherapy plus surgery

  • Original Article
  • Published:
Esophagus Aims and scope Submit manuscript

Abstract

Background

Esophageal cancer typically has a poor prognosis. While neoadjuvant chemotherapy (NAC) is reported to be effective for esophageal cancer patients, the prognosis of patients for whom NAC is ineffective remains poor.

Methods

In total, 113 patients with thoracic esophageal squamous cell carcinoma who were treated between January 2006 and December 2015 were enrolled. These patients received NAC followed by radical surgery and had three or more pathologic positive lymph nodes. The effectiveness and feasibility of adjuvant chemotherapy (AC) were evaluated.

Results

Forty patients received AC (AC(+) group) and 73 patients did not (AC(−) group). Two-year relapse-free survival (RFS) rates of the AC(+) and AC(−) groups were 30.0% and 28.8%, respectively (p = 0.47). These patients were further divided into two subgroups, i.e., those with 3–6 positive lymph nodes (3–6 subgroup) and those with ≥ 7 positive lymph nodes (≥ 7 subgroup). Within the 3–6 subgroup (72 patients), 2-year RFS rates of the AC(+) and AC(−) groups were 38.5% and 33.9%, respectively (p = 0.31). Within the ≥ 7 subgroup (41 patients), 2-year RFS rates of the AC(+) and AC(−) groups were 25.9% and 7.1%, respectively (p = 0.04).

Conclusions

AC may offer a significant additional benefit to the prognosis of esophageal cancer patients who have many positive lymph nodes even after NAC.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Yamasaki M, Yasuda T, Yano M, et al. Multicenter randomized phase II study of cisplatin and fluorouracil plus docetaxel (DCF) compared with cisplatin and fluorouracil plus Adriamycin (ACF) as preoperative chemotherapy for resectable esophageal squamous cell carcinoma (OGSG1003). Ann Oncol. 2017;28(1):116–20.

    Article  CAS  Google Scholar 

  2. Ando N, Kato H, Igaki H, et al. A randomized trial comparing postoperative adjuvant chemotherapy with cisplatin and 5-fluorouracil versus preoperative chemotherapy for localized advanced squamous cell carcinoma of the thoracic esophagus (JCOG9907). Ann Surg Oncol. 2012;19(1):68–74.

    Article  Google Scholar 

  3. van Hagen P, Hulshof MC, van Lanschot JJ, et al. Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med. 2012;366(22):2074–84.

    Article  Google Scholar 

  4. Shapiro J, van Lanschot JJB, Hulshof MCCM, et al. Neoadjuvant chemoradiotherapy plus surgery versus surgery alone for oesophageal or junctional cancer (CROSS): long-term results of a randomised controlled trial. Lancet Oncol. 2015;16(9):1090–8.

    Article  Google Scholar 

  5. Chao YK, Chuang WY, Chang HK, et al. Prognosis of patients with esophageal squamous cell carcinoma who achieve major histopathological response after neoadjuvant chemoradiotherapy. Eur J Surg Oncol. 2017;43(1):234–9.

    Article  Google Scholar 

  6. Rizvi FH, Syed AA, Khattak S, et al. Complete pathological response after neoadjuvant treatment in locally advanced esophageal cancer predicts long term survival: a retrospective cohort study. Int J Surg. 2014;12(6):621–5.

    Article  Google Scholar 

  7. Donahue JM, Nichols FC, Li Z, et al. Complete pathologic response after neoadjuvant chemoradiotherapy for esophageal cancer is associated with enhanced survival. Ann Thorac Surg. 2009;87(2):392–8.

    Article  Google Scholar 

  8. Hamai Y, Hihara J, Emi M, et al. Evaluation of prognostic factors for esophageal squamous cell carcinoma treated with neoadjuvant chemoradiotherapy followed by surgery. World J Surg. 2018;42(5):1496–505.

    Article  Google Scholar 

  9. Chen M, Shen M, Lin Y, et al. Adjuvant chemotherapy does not benefit patients with esophageal squamous cell carcinoma treated with definitive chemoradiotherapy. Radiat Oncol. 2018;13(1):150.

    Article  Google Scholar 

  10. Japanese Classification of Esophageal Cancer. 11th ed. The Japan Esophageal Society; 2015.

  11. Kunath U, Fischer P. Radical nature and life expectancy in the surgical treatment of esophageal and cardial carcinoma. Dtsch Med Wochenschr. 1984;109:450–3.

    Article  CAS  Google Scholar 

  12. Teniere P, Hay JM, Fingerhut A, et al. Postoperative radiation therapy does not increase survival after curative resection for squamous cell carcinoma of the middle and lower esophagus as shown by a multicenter controlled trial. French University Association for Surgical Research. Surg Gynecol Obstet. 1991;173:123–30.

    CAS  PubMed  Google Scholar 

  13. Fok M, Sham JS, Choy D, et al. Postoperative radiotherapy for carcinoma of the esophagus: a prospective, randomized controlled study. Surgery. 1993;113:138–47.

    CAS  PubMed  Google Scholar 

  14. Zieren HU, Muller JM, Jacobi CA, et al. Adjuvant postoperative radiation therapy after curative resection of squamous cell carcinoma of the thoracic esophagus: a prospective randomized study. World J Surg. 1995;19:444–9.

    Article  CAS  Google Scholar 

  15. Xiao ZF, Yang ZY, Liang J, et al. Value of radiotherapy after radical surgery for esophageal carcinoma: a report of 495 patients. Ann Thorac Surg. 2003;75:331–6.

    Article  Google Scholar 

  16. Pouliquen X, Levard H, Hay JM, et al. 5-Fluorouracil and cisplatin therapy after palliative surgical resection of squamous cell carcinoma of the esophagus. A multicenter randomized trial. French Associations for Surgical Research. Ann Surg. 1996;223:127–33.

    Article  CAS  Google Scholar 

  17. Ando N, Iizuka T, Kakegawa T, et al. A randomized trial of surgery with and without chemo- therapy for localized squamous carcinoma of the thoracic esophagus: the Japan Clinical Oncology Group Study. J Thorac Cardiovasc Surg. 1997;114:205–9.

    Article  CAS  Google Scholar 

  18. Ando N, Iizuka T, Ide H, et al. Surgery plus chemotherapy compared with surgery alone for localized squamous cell carcinoma of the thoracic esophagus: a Japan Clinical Oncology Group Study-JCOG9204. J Clin Oncol. 2003;21(24):4592–6.

    Article  Google Scholar 

  19. Zhang J, Chen HQ, Zhang YW, et al. Adjuvant chemotherapy in oesophageal cancer: a meta-analysis and experience from the Shanghai Cancer Hospital. J Int Med Res. 2008;36(5):875–82.

    Article  CAS  Google Scholar 

  20. Zhao Y, Dai Z, Min W, et al. Perioperative versus preoperative chemotherapy with surgery in patients with resectable squamous cell carcinoma of esophagus: a phase III randomized trial. J Thorac Oncol. 2015;10(9):1349–56.

    Article  CAS  Google Scholar 

  21. Kato K, Tahara M, Hironaka S, et al. A phase II study of paclitaxel by weekly 1-h infusion for advanced or recurrent esophageal cancer in patients who had previously received platinum-based chemotherapy. Cancer Chemother Pharmacol. 2011;67(6):1265–72.

    Article  CAS  Google Scholar 

  22. Muro K, Hamaguchi T, Ohtsu A, et al. A phase II study of single-agent docetaxel in patients with metastatic esophageal cancer. Ann Oncol. 2004;15(6):955–9.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2-E2, Yamadaoka, Suita, Osaka, 565-0879, Japan

    Norihiro Matsuura, Makoto Yamasaki, Kotaro Yamashita, Koji Tanaka, Tomoki Makino, Takuro Saito, Kazuyoshi Yamamoto, Tsuyoshi Takahashi, Yukinori Kurokawa, Kiyokazu Nakajima, Hidetoshi Eguchi & Yuichiro Doki

  2. Department of Surgery, Osaka General Medical Center, Osaka, Japan

    Masaaki Motoori

  3. Department of Surgery, Kindai University Faculty of Medicine, Osaka, Japan

    Yutaka Kimura

Authors
  1. Norihiro Matsuura
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Makoto Yamasaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kotaro Yamashita
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Koji Tanaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tomoki Makino
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Takuro Saito
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Kazuyoshi Yamamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Tsuyoshi Takahashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Yukinori Kurokawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Masaaki Motoori
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Yutaka Kimura
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Kiyokazu Nakajima
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Hidetoshi Eguchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Yuichiro Doki
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Makoto Yamasaki.

Ethics declarations

Ethical Statement

This study was conducted in accordance with the World Medical Association Declaration of Helsinki.

Conflict of interest

All authors declare that they have no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 26 KB)

10388_2020_811_MOESM2_ESM.docx

Supplementary file2 Figure S. Kaplan-Meier curves for overall survival after recurrence of patients who had more than 7 pathologic positive lymph nodes and recurrence in the AC(+) and AC(-) groups. Red and blue lines correspond to the AC(+) and AC(-) groups, respectively. AC, adjuvant chemotherapy (DOCX 949 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Matsuura, N., Yamasaki, M., Yamashita, K. et al. The role of adjuvant chemotherapy in esophageal cancer patients after neoadjuvant chemotherapy plus surgery. Esophagus 18, 559–565 (2021). https://doi.org/10.1007/s10388-020-00811-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10388-020-00811-z

Keywords

Search

Navigation