Identification of a predictive factor for distant metastasis in esophageal squamous cell carcinoma after definitive chemoradiotherapy

• Published in: International journal of clinical oncology 2016-10, Vol.21 (5), p.899-908
• Main Authors: Sakanaka, Katsuyuki, Ishida, Yuichi, Itasaka, Satoshi, Ezoe, Yasumasa, Aoyama, Ikuo, Miyamoto, Shinichi, Horimatsu, Takahiro, Muto, Manabu, Hiraoka, Masahiro
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Cancer Research; Carcinoma, Squamous Cell - secondary; Carcinoma, Squamous Cell - therapy; Chemoradiotherapy; Chemotherapy; Esophageal cancer; Esophageal Neoplasms - pathology; Esophageal Neoplasms - therapy; Female; Fluorouracil - administration & dosage; Follow-Up Studies; Humans; Lymph Nodes - pathology; Lymphatic Metastasis; Lymphatic system; Male; Medicine; Medicine & Public Health; Metastasis; Middle Aged; Neoplasm Staging; Oncology; Organ Size; Original Article; Platinum Compounds - administration & dosage; Radiation therapy; Retrospective Studies; Risk Factors; Surgical Oncology; Survival Rate; Tumor Burden
• ISSN: 1341-9625; 1437-7772
• DOI: 10.1007/s10147-016-0967-z

Background and purpose Distant metastasis (DM) after definitive chemoradiotherapy has not been a focus of research in esophageal carcinoma. At present, local–regional control is improving following advances in salvage treatments after definitive chemoradiotherapy. There is a need to focus on suppressing the development of DM. The aim of this study was to identify pre-treatment factors associated with DM after definitive chemoradiotherapy. Materials and methods This study included 144 patients with thoracic esophageal squamous cell carcinoma (Stage I/II/III/IV; 35/17/69/23) (TNM 7th) who underwent definitive chemoradiotherapy; >50 Gy was prescribed to all gross tumors with concurrent administration of 5-fluorouracil ± platinum. Pre-treatment factors included age, gender, performance status, tumor location, T/N/M status, tumor length, size of metastatic lymph nodes (LN size), and the presence of intramural metastasis or multiple primary tumors. The effects of pre-treatment factors on overall survival (OS) and DM were evaluated. Results The median follow-up period was 48 months. DM occurred as an initial progression in 21 % of patients, and LN size correlated with DM development (hazard ratio [HR] = 5.12; p  = 0.0013) and poor OS (HR = 2.20; p  = 0.0076) in univariate and multivariate analyses. Conclusions LN size is a quantitative pre-treatment prognostic factor that should be assessed prior to definitive chemoradiotherapy. Patients with large metastatic lymph nodes are at high risk of DM and should be monitored.