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Early and Persistent Dysphagia Relief Predicts Tumor Response in Esophageal Squamous Cell Carcinoma Patients Treated with Immunochemotherapy

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

Abstract

Background

In this prospective study, we aimed to investigate the role of patient-reported dysphagia relief in predicting pathological tumor responses to neoadjuvant immunochemotherapy (NAIC) in locally advanced esophageal squamous cell carcinoma (ESCC) patients.

Methods

This study was designed as a multi-center, prospective study including ESCC patients who received NAIC in the discovery and validation cohorts. The patients’ responses to the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-OES 18 and QLQ-C30 were collected at multiple time points. Subsequent time point-intensive esophageal cancer-specific dysphagia trajectories were depicted using growth mixture modeling (GMM) analysis. Furthermore, univariate and multivariate binary logistic regression was used to assess the independent predictors for pathological tumor responses.

Results

A total of 120 patients from the discovery cohort and 42 patients from the validation cohort were included in the analysis. In the discovery cohort, 19 (22.9%) of the 83 patients achieved pCR status. In the independent validation cohort, 24 patients underwent surgery, and 9 (37.5%) patients achieved pCR status. Trajectory analysis showed that, in the pCR group, the beginning of rapid declines in the slope occurred on days 3, 6, and 9. Further multivariate analysis showed that the degree of dysphagia relief (△dysphagia%) was the only significant independent predictor for pCR status (OR = 3.267, 95% CI 1.66–6.428, P < 0.001). The AUC value for △dysphagia% was 0.961 (95% CI: 0.922–0.999, P < 0.001).

Conclusion

The current study demonstrated that a longitudinal patient-reported outcome (PRO) was an easily obtained, cost-effective, and noninvasive tool for predicting tumor responses to neoadjuvant immunochemotherapy.

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Data Availability

All data needed to evaluate the conclusions in the paper are present in the paper and/or the Supplementary Materials.

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Acknowledgements

None.

Funding

This work was supported by a grant from the 2020–2021 Popularization of Science and Technology Innovation Special Project of Guangdong Province of China (2020A1414070007); the Science and Technology Program of Guangzhou, China (202206010103); and the Natural Science Foundation of Guangdong Province (2022A1515012469).

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Author notes

  1. Shujie Huang, Yong Tang and Hansheng Wu have contributed equally to this work.

Authors and Affiliations

  1. Department of Thoracic Surgery, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, People’s Republic of China

    Shujie Huang MD, Yong Tang MD, Jiming Tang MD, Xiaosong Ben MD, Dongkun Zhang MD, Liang Xie MD, Haiyu Zhou MD, Gang Chen MD, Sichao Wang MD, Zhen Gao MD, Rixin Chen PhD & Guibin Qiao MD, PhD

  2. Shantou University Medical College, Shantou, People’s Republic of China

    Shujie Huang MD

  3. Department of Thoracic Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, People’s Republic of China

    Hansheng Wu MD & Zefeng Xie MD

  4. School of Public Health and Management, Chongqing Medical University, Chongqing, People’s Republic of China

    Qiuling Shi MD, PhD

  5. Research Center of Medical Sciences, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, People’s Republic of China

    Rixin Chen PhD

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  1. Shujie Huang MD
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Contributions

SH, YT & HW: Conceptualization; Data curation; Formal analysis; Investigation; Methodology; Writing—original draft; Writing—review & editing. QS: Statistical analysis consultation; Writing—original draft; Writing—review & editing. JT, XB, DZ, LX, HZ, GC, SW & ZG: Software; Validation; Visualization; Investigation; Methodology; Writing—original draft; Writing—review & editing. RC & GQ: Funding acquisition; Project administration; Resources; Supervision; Writing—original draft; Writing—review & editing.

Corresponding authors

Correspondence to Rixin Chen PhD or Guibin Qiao MD, PhD.

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Informed consent was obtained from all patients during the online questionnaire distribution period.

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Informed consent was obtained from all patients during the online questionnaire distribution period.

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Huang, S., Tang, Y., Wu, H. et al. Early and Persistent Dysphagia Relief Predicts Tumor Response in Esophageal Squamous Cell Carcinoma Patients Treated with Immunochemotherapy. Ann Surg Oncol 30, 5171–5181 (2023). https://doi.org/10.1245/s10434-023-13467-7

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