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Optimal Time-to-Surgery Recommendations Based on Primary Tumor Volume Regression for Patients with Resectable Esophageal Cancer after Neoadjuvant Chemoradiotherapy: A Retrospective Study

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Neoadjuvant chemoradiotherapy (NCRT) has shown promise in improving the prognosis of individuals with locally advanced esophageal squamous cell carcinoma (LA-ESCC). However, the factors influencing tumor response and long-term survival in these patients remain unknown. The optimal timing for surgery after the completion of radiotherapy in LA-ESCC remains controversial. Therefore, this study was designed to identify biomarkers and to determine the optimal post-NCRT time-to-surgery (TTS) for patients with LA-ESCC.

Methods

This retrospective study included patients with resectable LA-ESCC who underwent NCRT between May 2017 and June 2021. The tumor shrinkage rate was calculated as the difference between the pre- and post-primary gross tumor volume (GTVp) divided by the pre-GTVp. Univariate and multivariate Cox regression analyses and Kaplan–Meier curves were used to calculate overall survival (OS) and progression-free survival (PFS).

Results

We collected data from 248 patients with resectable LA-ESCC who underwent computed tomography (CT) scans before the initiation of treatment. The median follow-up time was 37.7 months. The optimal cutoff of tumor shrinkage was 45%. In the univariate and multivariate analyses, we found a significant association between the tumor shrinkage rate and PFS (p = 0.001). Among the subgroup of patients who responded to treatment, extending the TTS was associated with improved OS (p = 0.037) and PFS (p = 0.028).

Conclusions

For patients with resectable LA-ESCC, the tumor shrinkage rate is an independent prognostic factor for PFS. Thus, for responders, prolonging TTS is recommended to obtain a better OS.

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Acknowledgments

The authors thank Editage (www.editage.cn) for English language editing.

Funding

The Science and Technology Department of Sichuan Province (Grant Nos.2023YFQ0055 and 2023YFS0488) supported this work.

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Authors and Affiliations

  1. School of Medicine, University of Electronic Science and Technology of China, Chengdu, China

    Jingqiu Li MD, Xiaoding Zhou MD & Ying Liu MD

  2. Department of Radiation Oncology, Radiation Oncology Key Laboratory of Sichuan Province, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China

    Jingqiu Li MD, Xiaoding Zhou MD, Jie Zhu MD, Gang Wan MD, Yi Wang MD, Lei Wu MD & Qifeng Wang MD

  3. Clinical Medical College, Chengdu Medical College, Chengdu, China

    Ying Liu MD

  4. Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China

    Xuefeng Leng MD, Yongtao Han MD & Lin Peng MD

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Contributions

JQL composed the manuscript. XDZ, YL, JZ, GW, YW, XFL, and YTH collected the data. LP, LW, and QFW conceived the idea of the study.

Corresponding authors

Correspondence to Lin Peng MD, Lei Wu MD or Qifeng Wang MD.

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Li, J., Zhou, X., Liu, Y. et al. Optimal Time-to-Surgery Recommendations Based on Primary Tumor Volume Regression for Patients with Resectable Esophageal Cancer after Neoadjuvant Chemoradiotherapy: A Retrospective Study. Ann Surg Oncol 31, 3803–3812 (2024). https://doi.org/10.1245/s10434-024-14941-6

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