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Neoadjuvant chemotherapy for locally advanced esophageal cancer comparing cisplatin and 5-fluorouracil versus docetaxel plus cisplatin and 5-fluorouracil: a propensity score matching analysis

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Abstract

Background

The standard treatment for locally advanced esophageal cancer is preoperative chemotherapy with cisplatin and 5-fluorouracil (CF), followed by surgery. Although docetaxel plus cisplatin and 5-fluorouracil (DCF) has been reported to have favorable outcomes, no study has compared its therapeutic efficacy to that of standard treatment. This study aimed to compare the therapeutic effects of CF and DCF in the real world by matching patient background factors using propensity scores.

Methods

We retrospectively reviewed the data of 237 patients with esophageal squamous cell carcinoma who underwent esophagectomy between January 2008 and December 2018. Patients were divided into two groups based on the preoperative chemotherapy regimens of CF (79 patients) or DCF (158 patients), and 49 matched pairs were finally analyzed using propensity score matching. Short- and long-term outcomes were compared between groups.

Results

After matching, although no significant differences in survival were observed among the groups, patients receiving DCF showed a significantly high histological response (P < 0.001). Subgroup analyses demonstrated that DCF therapy had better overall survival (P = 0.046) and relapse-free survival (P = 0.010) among pathological T3 and T4 cases. Whereas, adverse effects of chemotherapy were more frequent in the DCF group.

Conclusions

Patients receiving DCF had higher pathological response and better survival than those receiving CF, especially in pathological T3 and T4 cases matched using propensity scores. Thus, the DCF regimen might be an effective treatment for locally advanced esophageal cancer. However, the adverse side effects of chemotherapy remain high and should be handled appropriately.

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Acknowledgements

The authors thank Prof. Hiroshi Morimatsu (Department of Anaesthesiology, Okayama University Graduate School of Medicine and Dentistry) for their expert cooperation during esophagectomy and perioperative care. We thank Editage (www.editage.com) for English language editing.

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan

    Noriyuki Nishiwaki, Kazuhiro Noma, Tomoyoshi Kunitomo, Masashi Hashimoto, Naoaki Maeda, Shunsuke Tanabe, Kazufumi Sakurama, Yasuhiro Shirakawa & Toshiyoshi Fujiwara

  2. Shigei Medical Research Institute, Okayama, Japan

    Kazufumi Sakurama

  3. Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan

    Yasuhiro Shirakawa

Authors
  1. Noriyuki Nishiwaki
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  9. Toshiyoshi Fujiwara
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Contributions

Study conception and design: NN, KN, YS, and TF. Acquisition of data: NN, KN, TK, MH, NM, ST, and KS. Analysis and interpretation of data: NN, KN, YS, and TF. Drafting of manuscript: NN, KN, YS, and TF. Critical revision of manuscript: TK, MH, NM, ST, KS, YS, and TF.

Corresponding author

Correspondence to Kazuhiro Noma.

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Ethical approval

This study was conducted in accordance with the principles of the Declaration of Helsinki. We obtained approval from the ethics committee of Okayama University Hospital (Approval No. 2109–011).

Conflict of interest

The authors declare no conflict of interest.

Informed consent

Due to the retrospective design of this study, informed consent from the patient was not required.

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Supplementary Information

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10388_2022_934_MOESM1_ESM.docx

Supplementary file1 Additional supporting information can be found in the Supporting Information section online (DOCX 5165 KB)

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Nishiwaki, N., Noma, K., Kunitomo, T. et al. Neoadjuvant chemotherapy for locally advanced esophageal cancer comparing cisplatin and 5-fluorouracil versus docetaxel plus cisplatin and 5-fluorouracil: a propensity score matching analysis. Esophagus 19, 626–638 (2022). https://doi.org/10.1007/s10388-022-00934-5

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