Preoperative Assessment Using a Scoring System After Neoadjuvant Chemotherapy With Docetaxel, Cisplatin and 5-Fluorouracil for Locally Advanced Esophageal Cancer

Background Neoadjuvant chemotherapy (NAC) with docetaxel, cisplatin, and 5-fluorouracil (DCF) is highly effective for advanced esophageal squamous cell carcinoma, and patients with a good response sometimes desire to avoid surgery. The aim of this single-center, retrospective study was to predict the probability of tumor residuals using a newly devised scoring system and identify conditions that may obviate the need for surgery. Methods Between January 2017 and March 2024, 106 patients received NAC with DCF, followed by radical resection at our institution. After NAC, patients underwent multimodal assessments to correlate the evaluation parameters with tumor residuals. A scoring system was developed by incorporating the parameters that exhibited significant differences. After calculating the scores for all patients, a receiver operating characteristic (ROC) curve was generated to determine the optimal cutoff value for predicting tumor residuals. Results Eighteen patients achieved a pathological complete response, of whom 12 had complete tumor disappearance, including in the lymph nodes. The scoring system included the following seven parameters: endoscopic irregularity, elevation, and pink-color sign after iodine staining; identification of the main tumor, regional lymph nodes ≥5 mm in long diameter, presence of positive lymph node findings on computed tomography; and positive 18F-fluorodeoxyglucose uptake on positron emission tomography. The area under the ROC curve was 0.957, with a cutoff value of 3 for tumor residuals. All patients with a score of 0 showed complete tumor disappearance. Conclusion Our newly developed scoring system indicates that surgery may be safely omitted in cases where the biopsy result is negative and the score is 0. The preoperative multimodal assessment of cancer lesions, when scored, is anticipated to enhance the clarity of informed consent for patients and elevate the quality of shared decision-making between physicians and patients.