Borderline Resectable T3 in Locally Advanced Esophageal Squamous Cell Carcinoma Treated With Neoadjuvant Triplet Chemotherapy Followed by Esophagectomy

Background This study aimed to reveal patient characteristics in comparison of those with resectable clinical T3 (cT3r) and those with borderline resectable clinical T3 (cT3br) esophageal squamous cell carcinoma who underwent neoadjuvant chemotherapy using triplet regimen. Methods The study cohort comprised our patients (January 2010–November 2020) who underwent neoadjuvant chemotherapy using triplet regimen with DCF or DCS therapy followed by esophagectomy for cT3 esophageal squamous cell carcinoma. Eligible patients were divided into cT3r and cT3br groups. Diagnosis was cT3r in 101 patients and cT3br in 26 patients. Results The numbers of patients with complete response, partial response, stable disease and progressive disease were significantly different between the cT3r and cT3br groups (4.9%, 52.5%, 8.9% and 3.0% vs. 3.9%, 42.3%, 19.2% and 23.1%, respectively; P = 0.003). Surgical radicality of R0, R1 and R2 was significantly different between the cT3r and cT3br groups (93.0%, 4.0% and 3.0% vs. 57.6%, 7.7% and 34.7%, respectively; P < 0.001). In survival analysis, the three-year recurrence-free and overall survival rates were significant different between the groups (53.1% vs. 24.9%; P < 0.001, 59.8% vs. 32.6%, respectively; P < 0.001). Independent prognostic factors for overall survival were cT3br and histological response ≤1a. Conclusion cT3br and poorer histological response were prognostic factors of overall survival in this retrospective cohort study. Only performing neoadjuvant chemotherapy using triplet regimen for cT3br patients is perhaps insufficient to improve curability.