title: Risk factors of early recurrence within 6 months after esophagectomy following neoadjuvant chemotherapy for resectable advanced esophageal squamous cell carcinoma.
abstract: BACKGROUND
  Esophagectomy following neoadjuvant chemotherapy (NAC) is a standard treatment for resectable advanced esophageal cancer in Japan. However, approximately 10 % of patients with resectable advanced esophageal cancer experience recurrence within 6 months.
  
  
  METHODS
  One hundred twenty-eight patients with resectable advanced esophageal cancer underwent NAC between October 2008 and July 2015 in Kumamoto University Hospital. Among them, 82 patients with esophageal squamous cell carcinoma (SCC), who underwent curative esophagectomy without adjuvant treatment, were eligible. Clinicopathological factors correlated with early recurrence were retrospectively analyzed.
  
  
  RESULTS
  Of 82 patients, 14 (17 %) recurred within 6 months after surgery. The logistic regression analysis suggested that CRP before NAC ≥ 0.5 mg/dl [hazard ratio (HR) 33.8, 95 % confidence interval (CI) 2.767-413.9; p = 0.006), presence of poorly differentiated SCC component (HR 138, 95 % CI 5.339-3576; p = 0.003), and pathological vessel invasion (HR 16.3, 95 % CI 1.960-136.1; p = 0.010) were candidates for independent risk factors of early recurrence. Patients with at least two factors frequently recurred (82 %). Of 14 patients with early recurrence, 13 (93 %) had a distant metastasis.
  
  
  CONCLUSIONS
  Patients with resectable advanced esophageal cancer with at least two factors of CRP before NAC ≥ 0.5 mg/dl, presence of poorly differentiated SCC component, and pathological vessel invasion might be at high risk for early recurrence after esophagectomy following NAC. These patients might be considered for additional treatment and should be meticulously followed up after treatment.
authors.affiliation: Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuoku, Kumamoto, 860-8556, Japan.
authors.forename: Naoya
authors.initials: N
authors.lastname: Yoshida
authors.affiliation: Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuoku, Kumamoto, 860-8556, Japan.
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Baba
authors.affiliation: Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuoku, Kumamoto, 860-8556, Japan.
authors.forename: Hironobu
authors.initials: H
authors.lastname: Shigaki
authors.affiliation: Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuoku, Kumamoto, 860-8556, Japan.
authors.forename: Kazuto
authors.initials: K
authors.lastname: Harada
authors.affiliation: Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuoku, Kumamoto, 860-8556, Japan.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Iwatsuki
authors.affiliation: Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuoku, Kumamoto, 860-8556, Japan.
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Sakamoto
authors.affiliation: Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuoku, Kumamoto, 860-8556, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Miyamoto
authors.affiliation: Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuoku, Kumamoto, 860-8556, Japan.
authors.forename: Junji
authors.initials: J
authors.lastname: Kurashige
authors.affiliation: Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuoku, Kumamoto, 860-8556, Japan.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Kosumi
authors.affiliation: Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuoku, Kumamoto, 860-8556, Japan.
authors.forename: Ryuma
authors.initials: R
authors.lastname: Tokunaga
authors.affiliation: Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Watanabe
authors.affiliation: Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuoku, Kumamoto, 860-8556, Japan. hdobaba@kumamoto-u.ac.jp.
authors.forename: Hideo
authors.initials: H
authors.lastname: Baba
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology / Q000473:pathology / Q000628:therapy; D004938:Esophageal Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000628:therapy; D000077277:Esophageal Squamous Cell Carcinoma; D016629:Esophagectomy / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods / Q000706:statistics & numerical data; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000453:epidemiology; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors
keywords: Early recurrence; Esophageal cancer; Esophagectomy; Neoadjuvant chemotherapy