title: Impact of Chemoradiation-induced Myelosuppression on Prognosis of Patients with Locally Advanced Esophageal Cancer After Chemoradiotherapy Followed by Esophagectomy.
abstract: BACKGROUND
  The prognosis of patients with locally advanced esophageal squamous cell carcinoma (LAESC) is extremely poor. The impact of adverse effects of chemoradiotherapy (CRT), particularly myelosuppression, on postoperative long-term results has remained unclear.
  
  
  METHODS
  A total of 44 patients with LAESC who underwent CRT followed by esophagectomy were enrolled. We compared long-term survival by various clinical variables, including myelosuppression (Grade 3 and 4 leukopenia) due to CRT, response to CRT, performance status, postoperative complications, and pathological nodal status. Finally, multivariate analysis of prognostic factors was assessed by the Cox proportional hazards model.
  
  
  RESULTS
  The mean age of patients was 62.8 years and the male/female ratio was 32/9. The response rate to CRT was 75% (33/44), which included five cases with complete response and 28 cases with partial response. Grade 3 and 4 leukopenia was 43% (19/44). Mortality and postoperative pneumonia occurred in 3 (7.3%) and 14 cases (31.8%), respectively. Multivariate analysis demonstrated that myelosuppression was a significant negative prognostic factor in overall survival (OS) [hazard ratio (HR)=4.758, p=0.005]. The 5-year OS rate was significantly poorer in the group with myelosuppression than in the group without (15.4% vs. 69.0%, p=0.003). Discontinuation of the preoperative CRT schedule and dose reduction of chemotherapeutic agents was significantly more frequent in the group with myelosuppression than in the group without (p=0.003), and peripheral lymphocyte counts after surgery was significantly lower, which may explain poor prognosis in the group with myelosuppression.
  
  
  CONCLUSIONS
  Pre-operative CRT-induced myelosuppression has a negative impact on the prognosis of patients with LAESC. Our findings indicate that a careful postoperative follow-up is required for patients who develop myelosuppression after neoadjuvant CRT followed by curative resection for locally advanced esophageal cancer.
authors.affiliation: Department of Surgical Oncology, Graduate School of Medicine, Osaka City University, Osaka, Japan.
authors.forename: Masaichi
authors.initials: M
authors.lastname: Ohira
authors.affiliation: Department of Surgical Oncology, Graduate School of Medicine, Osaka City University, Osaka, Japan k-naoshi@med.osaka-cu.ac.jp.
authors.forename: Naoshi
authors.initials: N
authors.lastname: Kubo
authors.affiliation: Department of Gastroenterological Surgery, Osaka City General Hospital, Osaka, Japan.
authors.forename: Yoshito
authors.initials: Y
authors.lastname: Yamashita
authors.affiliation: Department of Surgical Oncology, Graduate School of Medicine, Osaka City University, Osaka, Japan.
authors.forename: Katsunobu
authors.initials: K
authors.lastname: Sakurai
authors.affiliation: Department of Surgical Oncology, Graduate School of Medicine, Osaka City University, Osaka, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Toyokawa
authors.affiliation: Department of Surgical Oncology, Graduate School of Medicine, Osaka City University, Osaka, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Tanaka
authors.affiliation: Department of Surgical Oncology, Graduate School of Medicine, Osaka City University, Osaka, Japan.
authors.forename: Kazuya
authors.initials: K
authors.lastname: Muguruma
authors.affiliation: Department of Surgical Oncology, Graduate School of Medicine, Osaka City University, Osaka, Japan.
authors.forename: Kosei
authors.initials: K
authors.lastname: Hirakawa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D059248:Chemoradiotherapy; D004938:Esophageal Neoplasms / Q000473:pathology* / Q000601:surgery / Q000628:therapy*; D016629:Esophagectomy; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies
keywords: Esophageal cancer; chemoradiation; myelosuppression