Prognostic factors after combined modality treatment of squamous cell carcinoma of the esophagus

Introduction: In a previous study of prognostic factors in patients with loco-regionally advanced adenocarcinoma of the esophagus treated with chemo-radiotherapy (CRT) followed by resection, we found that residual nodal disease was most prognostic of outcome. In this study, we evaluated prognostic factors among patients with squamous cell carcinoma (SCC) of the esophagus who have undergone a similar treatment regimen. Methods: A retrospective review of patients with SCC of the esophagus who received CRT before esophagectomy. Data collected included demographics, CRT details, pathologic findings, and survival. Statistical methods included recursive partitioning and Kaplan-Meier analyses. Results: From 1996 to 2006, 91 patients were appropriate for this analysis. Complete pathologic response in the primary tumor (pt-pCR) occurred in 49 patients (53.8%), including 10 of 91 (10.9%) who had a pt-pCR but residual nodal disease. Recursive partitioning analysis identified three prognostic groups: (1) group 1 (n = 52), patients with minimal residual local disease (pt-pCR and T1-N any); (2) group 2 (n = 28), patients with residual T2 disease (N0 and N1) and patients with T3-4N0 disease; and (3) group 3 (n = 11), patients with residual T3-4N1 disease. Three-year survival was 68.4% in group 1, 45.6% in group 2, and 0% in group 3 (p < 0.001). Conclusions: Unlike adenocarcinoma, in which residual nodal disease after CRT is the most significant predictor of survival, in SCC of the esophagus, pt-pCR or minimal residual local disease after CRT predicts the best survival. These findings aid the design of future clinical trials.