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The study aims to evaluate the predictive value of tumor reduction rate (TRR) after neoadjuvant chemotherapy for assessing treatment efficacy and prognosis in esophageal squamous cell carcinoma.

March 1, 2026Anticancer Research0 citations

Prediction of Pathological Response and Prognosis After Surgery by Tumor Reduction During Neoadjuvant Chemotherapy in Patients With Esophageal Squamous Cell Carcinoma

NKNAO KITASAKI YHYoichi HamaiHiroshima University RHRYOSUKE HIROHATA

Key Points

The study aims to evaluate the predictive value of tumor reduction rate (TRR) after neoadjuvant chemotherapy for assessing treatment efficacy and prognosis in esophageal squamous cell carcinoma.
Seventy-one patients treated with neoadjuvant chemotherapy followed by esophagectomy were analyzed.
Tumor reduction rate was calculated using CT imaging after two treatment cycles.
Multivariable analyses assessed the relationship between TRR, clinical features, and survival outcomes.
Median tumor reduction rate was 29.91%, with a cut-off of 20% for predicting pathological response.
Patients with TRR ≥20% had a higher proportion of ypT0-2 (68% vs. 33%) and ypN0-1 (82% vs. 57%).
Three-year recurrence-free survival was significantly higher in the TRR ≥20% group (65.8% vs. 44.4%; p=0.02).

Abstract

Background/Aim: Neoadjuvant chemotherapy with docetaxel, cisplatin, and 5-fluorouracil (NAC-DCF) is the standard treatment for locally advanced esophageal squamous cell cancer (ESCC) in Japan; however, reliable markers for early treatment efficacy prediction remain unclear. Patients and Methods: Seventy-one consecutive patients underwent NAC-DCF followed by esophagectomy in September 2012-October 2024. Tumor reduction rate (TRR), defined as the percentage decrease in the tumor area (short diameter×long diameter) after two courses of NAC-DCF, was evaluated using computed tomography (CT). We analyzed the relationship between TRR, clinicopathological parameters, and survival. Results: The median TRR was 29.91% (−34.2 to 74.2%). The optimal cut-off value of TRR for predicting pathological response was 20% area under the receiver operating characteristic curve (ROC)=0.717. Patients with TRR ≥20% showed a significantly higher proportion of ypT0-2 (68% vs. 33%), ypN0-1 (82% vs. 57%), and R0 resection rate (90% vs. 67%) than those with TRR vs. 44.4%, respectively; p=0.02). Conclusion: TRR after two courses of NAC-DCF may be a good predictor of pathological response, R0 resection, and prognosis in patients with ESCC undergoing NAC-DCF plus surgery.

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