title: Prognostic factors in esophageal squamous cell carcinoma patients treated with neoadjuvant chemoradiation therapy.
abstract: BACKGROUND
  Definitive evaluation of surgical specimens obtained after neoadjuvant chemoradiation therapy (CRT) is important for assessing additional treatment or prognosis in patients with esophageal squamous cell carcinoma (ESCC). In this study, we examined the histological prognostic factors for ESCC patients treated with CRT and determined an appropriate strategy for their evaluation.
  
  
  METHODS
  The present study involved 38 consecutive ESCC patients who underwent CRT followed by curative operation. CRT consisted of 5-fluorouracil plus cisplatin and 40 Gy of radiation. We examined histological variables as follows: CRT effect on primary tumor (T-effect: T-effective/T-ineffective), tumor depth (pT), lymph node metastases (pN: pN0/N1), number of lymph node metastases (number-pN), lymphatic invasion, and venous invasion. Univariate and multivariate analyses were performed to examine the independent prognostic factors. Survivals and mode of recurrence were then evaluated according to the independent prognostic factors.
  
  
  RESULTS
  In the univariate analyses, T-effect, pN, number-pN, lymphatic invasion, and venous invasion were found to be prognostic factors with p < 0.01, and pT was a factor with p < 0.05. In the multivariate analysis, pN and T-effect were independent prognostic factors. The five-year survival rate of pN0 patients was more than 75%, even though the T-effect was poor. The 5-year survival rate of patients judged as pN1/T-effective was 50%, whereas all of the pN1/T-ineffective patients died within 2 years with relapse disease.
  
  
  CONCLUSIONS
  The evaluation method using both pN status and T-effect is useful for assessing prognosis of ESCC patients treated with neoadjuvant CRT.
authors.affiliation: Department of Digestive Surgery, Breast and Thyroid Surgery, Graduate School of Medical Sciences, Kagoshima University, Sakuragaoka 8-35-1, Kagoshima, 890-8520, Japan. hokumura@m.kufm.kagoshima-u.ac.jp
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Okumura
authors.forename: Yasuto
authors.initials: Y
authors.lastname: Uchikado
authors.forename: Masataka
authors.initials: M
authors.lastname: Matsumoto
authors.forename: Tetsuhiro
authors.initials: T
authors.lastname: Owaki
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Kita
authors.forename: Itaru
authors.initials: I
authors.lastname: Omoto
authors.forename: Ken
authors.initials: K
authors.lastname: Sasaki
authors.forename: Toshihide
authors.initials: T
authors.lastname: Sakurai
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Setoyama
authors.forename: Bunpei
authors.initials: B
authors.lastname: Nabeki
authors.forename: Daisuke
authors.initials: D
authors.lastname: Matsushita
authors.forename: Sumiya
authors.initials: S
authors.lastname: Ishigami
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Hiraki
authors.forename: Masayuki
authors.initials: M
authors.lastname: Nakajo
authors.forename: Shoji
authors.initials: S
authors.lastname: Natsugoe
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D059248:Chemoradiotherapy; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D004938:Esophageal Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D016629:Esophagectomy; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis / Q000473:pathology / Q000532:radiotherapy; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000009:adverse effects; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D011379:Prognosis; D015996:Survival Rate
chemical_list: D002945:Cisplatin; D005472:Fluorouracil