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

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 <20%. In multivariable analyses, TRR ≥20% (HR=8.01, 95%CI=2.21-28.89) was an independent predictive factor for pathological response, and clinical response (HR=4.95, 95% CI=1.08-22.55) and TRR ≥20% (HR=3.03, 95% CI=1.01-13.38) were independent prognostic factors for R0 resection. TRR ≥20% showed a significantly higher 3-year RFS rate than TRR <20% (65.8% 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.