Abstract
Background
Accurate prediction of treatment response and prognosis before surgery allows prompt therapy adjustment. This study aimed to evaluate the efficacy of computed tomography (CT) signs in predicting treatment response and survival for advanced esophageal squamous cell carcinoma patients who received preoperative chemotherapy.
Methods
This study retrospectively enrolled 135 consecutive patients with preoperative chemotherapy from September 2005 to December 2011. A logistic regression model was used to evaluate the association between pathologic response and CT signs. Overall survival (OS) and disease-free survival (DFS) were estimated using the Kaplan–Meier method, and a Cox proportional hazards model was constructed to determine associations between CT signs after neoadjuvant chemotherapy and survival outcomes.
Results
Logistic regression showed that the significant predictors of a poor response were the total number of lymph nodes (LNs) (>6) at baseline [odds ratio (OR) 5.07; 95 % confidence interval (CI) 1.86–13.81; P = 0.002] and the CT value change rate (≤17 %) (OR 2.35; 95 % CI 1.05–5.23; P = 0.037). In the Cox analyses, the significant predictors of OS were preoperative tumor thickness (>10 mm) [hazard ratio (HR) 2.33; 95 % CI 1.36–4; P = 0.002), total number of LNs (>6) (HR 1.88; 95 % CI 1.12–3.17; P = 0.017), and short diameter of the largest LN (>10 mm) (HR 1.87; 95 % CI 1.07–3.28; P = 0.028), whereas only the short diameter of the largest LN was a significant predictor of DFS (HR 2.36; 95 % CI 1.23–4.54; P = 0.01).
Conclusions
CT signs can predict therapeutic efficacy and survival outcomes and provide an opportunity to offer additional treatment options before surgery.
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Acknowledgment
This work was supported by the National Basic Research Program of China (973 Program) (Grant No. 2011CB707705, 2011CB504300), National Natural Science Foundation of China (Grant No. 81471640, 81301748), the Capital Health Research and Development of Special Foundation (Grant No. 2011-2015-02), Specialized Research Fund for the Doctoral Program of Higher Education (Grant No. 20130001110108), Beijing Health System High Level Health Technical Personnel Training Plan (Grant No. 2013-3-083), Education Ministry Innovative Research Team in University (Grant No.IRT13003), Beijing Academic Leaders Program (Grant No. 2009-2-17), Beijing Natural Science Foundation (Grant No. 7102029), Capital Medical Developed Research Found (Grant No. 2007-1023), New Scholar Star Program of Ministry of Education.
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Xiao-Yan Zhang and Wan-Pu Yan have contributed equally to this work.
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10434_2015_4531_MOESM2_ESM.tif
Supplementary Fig. 2. (A) Kaplan–Meier curves of pathological response on overall survival (OS); (B) Kaplan–Meier analysis of pathological response on disease-free survival (DFS) (TIFF 970 kb)
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Zhang, XY., Yan, WP., Sun, Y. et al. CT Signs Can Predict Treatment Response and Long-Term Survival: A Study in Locally Advanced Esophageal Cancer with Preoperative Chemotherapy. Ann Surg Oncol 22 (Suppl 3), 1380–1387 (2015). https://doi.org/10.1245/s10434-015-4531-2
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DOI: https://doi.org/10.1245/s10434-015-4531-2