Comparison of Long-Term Outcomes Between Doublet and Triplet Neoadjuvant Chemotherapy for Patients With Locally Advanced Esophageal Squamous Cell Carcinoma

Background The neoadjuvant triplet chemotherapy with docetaxel, cisplatin, and 5-fluorouracil for resectable locally advanced esophageal squamous cell carcinoma has become standard therapy, replacing doublet therapy with cisplatin and 5-fluorouracil due to the result of JCOG1109. In addition, the surgical procedures have been standardized with a focus on minimally invasive esophagectomy since early on in our institution. The present study aimed to compare the long-term outcomes of triplet and doublet chemotherapy as neoadjuvant chemotherapy for patients with locally advanced esophageal squamous cell carcinoma in a standardized surgical procedure population using propensity score matching. Methods A total of 764 patients (277 patients of triplet group and 487 patients of doublet group) in all of our cohorts and the propensity score matched 452 patients (226 patients each for triplet and doublet group) who had undergone neoadjuvant chemotherapy followed by thoracic esophagectomy with a three-field lymphadenectomy between January 2009 and December 2017, were retrospectively reviewed. Results In the matching cohort, there were not any differences in overall survival between the two groups, however, there are significant differences in progression-free survival. Triplet group has a better prognosis than doublet group(p = 0.03). In subgroup analysis, cT3/4 cases (p = 0.04) and cN positive cases (p = 0.03), PFS was particularly significantly longer in the DCF group. In searching for risk factors for recurrence, pT3/4, pN positive, and lymphovascular invasion positive cases were identified as the risk factor in both groups as a result of multivariate analysis. Conclusion Triplet chemotherapy group is more effective in preventing the recurrence of locally advanced esophageal squamous cell carcimoa followed by standarlized esophagectomy. Moreover, pT3/4, pN positive, and lymphovascular invasion positive are risk factors for recurrence after neoadjuvant chemotherapy followed by esophagectomy.