Pathologic Staging with Taxane-basedNeoadjuvant chemoradiotherapy Correlateswith Increased Survival in Patients with LocallyAdvanced Esophageal Cancer

Background: The treatment of resectable stages of esophageal cancer often involves pre-operative concurrent chemoradiotherapy. This study aims to evaluate the effect of cisplatin/paclitaxel-based neoadjuvant chemoradiotherapy on pathologic stage and survival in patients with locally advanced esophageal cancer. Methods: Patients (n=67) received cisplatin/paclitaxel-based induction chemoradiotherapy followed by esophagectomy. Survival calculated from time of surgery was stratified by pathologic stage and controlled for clinical factors. Results: Clinical factors included: age (range 40 to 76 years); gender (64 male; 3 female); and histology (59 adeno; 8 squamous cell). Pretreatment stages were: IIA (n=2); IIB (n=8); III (n=49) and IVa (n=8). Treatment led to downstaging in 54 patients, and 19 patients achieved a pathologic complete response (pCR). Post-treatment (pathologic) stages were: 0 (n=19); I (n=6); IIA (n=26); IIB (n=7); III (n=6); IV (n=3). Median survival was 47.5 months with minimum follow up of 5 months for surviving patients. Number of stage reductions did not correlate with survival (p=0.83 by chi2), and 6/13 patients with no downstaging are alive at the time of analysis. Median survivals for each pathologic stage were: 0 (not reached); I (31 months); IIA (35 months); IIB (17 months); III (11 months); and IV (4 months)—[p <0.01 by logrank test]. In a Cox multivariate model adjusted for age, gender and histology, higher pathologic stage correlated with worse survival (HR 1.44; 95% CI 1.12-1.86). Conclusions: Cisplatin/paclitaxel-based neoadjuvant chemoradiotherapy for resectable esophageal cancer leads to pathologic downstaging in most patients, and lower pathologic stage correlates with better survival.