title: A Prognostic Scoring Model for the Utility of Induction Chemotherapy Prior to Neoadjuvant Chemoradiotherapy in Esophageal Cancer.
abstract: The aim of this study was to identify patients with esophageal cancer who may benefit from induction chemotherapy (IC) before neoadjuvant chemoradiotherapy (nCRT) on the basis of a prognostic scoring model.
  
  
  
  Between 1998 and 2015, 535 patients with esophageal cancer who underwent nCRT were included for analysis, including 218 patients who received IC before nCRT (IC group) and 317 patients who did not receive IC (non-IC group). A prognostic scoring model was developed to predict disease-free survival (DFS) on the basis of a Cox proportional hazards model.
  
  
  
  The median follow-up time was 63.5 months (range 8.0-178.5) for survivors. The 5-year DFS rates were similar between the IC and non-IC groups (53.7% vs. 45.1%, p = 0.196). Multivariate analysis determined that histologic grade, tumor location, baseline positron emission tomography maximum standard uptake value, and lymph node size were independent prognostic factors for DFS. A prognostic scoring system was constructed by using these four factors, with the total score ranging from 0 to 6.2. When the median value was used as a cutoff, low-risk (≤3.5) and high-risk (>3.5) groups were identified. In the high-risk group, patients who received IC had a nonsignificantly higher pathologic complete response rate (p = 0.272) and a significantly better DFS (p = 0.03) than patients who did not receive IC. After propensity score matching, the high-risk group demonstrated a significantly improved DFS with IC, a benefit that was not observed in the low-risk group.
  
  
  
  On the basis of the prognostic scoring model, the addition of IC to nCRT may provide a DFS benefit in high-risk patients with a risk score higher than 3.5. Prospective validation is warranted.
authors.affiliation: Department of Radiation Oncology, Cancer Center, Sun Yat-Sen University, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China.
authors.forename: Mian
authors.initials: M
authors.lastname: Xi
authors.affiliation: Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas.
authors.forename: Zhongxing
authors.initials: Z
authors.lastname: Liao
authors.affiliation: Division of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas School of Public Health, Houston, Texas.
authors.forename: Weiye
authors.initials: W
authors.lastname: Deng
authors.affiliation: Department of Radiation Oncology, Cancer Hospital/Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
authors.forename: Cai
authors.initials: C
authors.lastname: Xu
authors.affiliation: Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas.
authors.forename: Ritsuko
authors.initials: R
authors.lastname: Komaki
authors.affiliation: Gastrointestinal Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas.
authors.forename: Mariela
authors.initials: M
authors.lastname: Blum
authors.affiliation: Cardiovascular and Thoracic Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas.
authors.forename: Wayne L
authors.initials: WL
authors.lastname: Hofstetter
authors.affiliation: Gastrointestinal Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas.
authors.forename: Linus
authors.initials: L
authors.lastname: Ho
authors.affiliation: Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas. Electronic address: shlin@mdanderson.org.
authors.forename: Steven H
authors.initials: SH
authors.lastname: Lin
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000628:therapy; D018279:Carcinoma, Signet Ring Cell / Q000473:pathology / Q000628:therapy; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000628:therapy; D059248:Chemoradiotherapy / Q000401:mortality*; D004938:Esophageal Neoplasms / Q000473:pathology* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D060828:Induction Chemotherapy / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D020360:Neoadjuvant Therapy / Q000401:mortality*; D011379:Prognosis; D057216:Propensity Score; D012189:Retrospective Studies; D015996:Survival Rate
keywords: Esophageal cancer; Induction chemotherapy; Neoadjuvant chemoradiotherapy; Prognosis