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Downstaging and Histological Effects Might Be Reliable Predictors of the Efficacy of DOC+CDDP+5-FU (DCF) as Neoadjuvant Therapy for Stage III or Borderline Resectable Esophageal Cancer: a Single Institute Experience

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Abstract

Purpose

In Japan, two courses of CDDP+5-FU (CF) therapy followed by surgery are accepted as a standard treatment for stage II/III esophageal cancer (EC) based on the results of the JCOG9907 trial. To gain a better survival, benefit especially for stage III patients in comparison with CF therapy, a three-arm phase III trial (neoadjuvant setting: CF vs. CF + radiation vs. DOC+CF [DCF]) is ongoing. We have aggressively performed DCF therapy for stage III or IV patients since October 2014. We herein review the outcomes of DCF therapy.

Methods

We retrospectively reviewed the cases of 27 patients with stage III or IV EC (male, n = 24; female, n = 3; median age, 70.0 years) who received DCF therapy.

Results

The response rate was 48.1%. Downstaging was achieved over the course of treatment in 14 patients (51.9%). Twenty-six patients transitioned to surgery, with 25 receiving R0 resection. DCF-treated patients who achieved downstaging showed significantly longer relapse-free survival (RFS) than those without downstaging (p = 0.0002). DCF-treated patients with a grade ≥ 1b histological effect showed significantly longer RFS than those with a grade < 1b effect (p = 0.0282). The multivariate analysis showed that downstaging was the only factor significantly associated with RFS in DCF-treated patients.

Conclusions

DCF therapy for stage ≥ III esophageal carcinoma is both feasible and effective. These findings suggest that downstaging and the histological effect might predict the effects of DCF therapy for EC.

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Data Availability

All data generated or analyzed during this study are included in this published article [and its supplementary information files].

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Acknowledgments

We thank Dr. Brian Quinn of Japan Medical Communication for his assistance with the writing of this manuscript.

Code Availability

Software application (mac OS high Sierra ver. 10.13.6), Word (for text and tables), Power Point (for figures) ver. 16.16.20, and Stat View J ver. 5.0 (for Kaplan Meier curve).

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Authors and Affiliations

  1. Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8501, Japan

    Kazuma Kobayashi, Kengo Kanetaka, Akira Yoneda, Shinichiro Kobayashi, Yasuhiro Maruya, Yuriko Isagawa, Tomoko Yoshimoto, Kazushige Migita, Yuta Kawaguchi, Sayaka Kuba, Michi Morita, Satomi Okada, Taiichiro Kosaka, Shun Yamaguchi, Yusuke Inoue, Tomohiko Adachi, Masaaki Hidaka, Yasuhiro Torashima, Shinichiro Ito, Mitsuhisa Takatsuki & Susumu Eguchi

  2. Tissue Engineering and Regenerative Therapeutics in Gastrointestinal Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan

    Kengo Kanetaka & Yasuhiro Maruya

  3. Department of Surgery, National Hospital Organization Nagasaki Medical Center, Oomura, Japan

    Shinichiro Kobayashi

  4. Department of Digestive and General Surgery, Graduate School of Medicine, University of Ryukyus, Okinawa, Japan

    Mitsuhisa Takatsuki

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  1. Kazuma Kobayashi
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  2. Kengo Kanetaka
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  20. Mitsuhisa Takatsuki
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  21. Susumu Eguchi
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Corresponding author

Correspondence to Kazuma Kobayashi.

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Conflict of Interest

The authors declare that they have no conflicts of interest.

Ethical Approval

This study is the part of an observation study on the treatment of esophageal cancer in our institution and has received approval from the internal review board of Nagasaki University Hospital (2019/10/22 IRB No. 19102114).

Consent to Participate

Informed consent are given by all the patients according to this observational study manual, and information of this study is demonstrated in our hospital home page for opt out patients.

Consent for Publication

Additional informed consent was obtained from all individual participants for whom identifying information is included in this article.

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Kobayashi, K., Kanetaka, K., Yoneda, A. et al. Downstaging and Histological Effects Might Be Reliable Predictors of the Efficacy of DOC+CDDP+5-FU (DCF) as Neoadjuvant Therapy for Stage III or Borderline Resectable Esophageal Cancer: a Single Institute Experience. J Gastrointest Canc 52, 582–592 (2021). https://doi.org/10.1007/s12029-020-00431-x

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  • DOI: https://doi.org/10.1007/s12029-020-00431-x

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