Impact of Perineural Invasion and Preexisting Type 2 Diabetes on Patients with Esophageal Squamous Cell Carcinoma Receiving Neoadjuvant Chemoradiotherapy

• Published in: Cancers Vol. 15; no. 4; p. 1122
• Main Authors: Su, Nai-Wen, Mok, Lai-Man, Chan, Mei-Lin, Liu, Hung-Chang, Chang, Wei-Chin, Yun, Chun-Ho, Shieh, Tze-Yu, Wu, Ming-Che, Lin, Huan-Chau, Huang, Wen-Chien, Chen, Yu-Jen
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 09.02.2023; MDPI
• Subjects: Cancer; Cancer therapies; Care and treatment; Chemoradiotherapy; Chemotherapy; Clinical outcomes; Diabetes; Diabetes mellitus (non-insulin dependent); Dissection; Drug dosages; Esophageal cancer; Esophagus; Head & neck cancer; Lymphatic system; Medical prognosis; Metastases; Metastasis; Methods; Multivariate analysis; Ostomy; Patients; Radiation; Radiotherapy; Squamous cell carcinoma; Statistical significance; Surgery; Survival analysis; Tomography; Tumors; Type 2 diabetes; Taiwan; United States > US; perineural invasion; esophageal squamous cell carcinoma; neoadjuvant chemoradiotherapy; type 2 diabetes
• ISSN: 2072-6694; 2072-6694
• DOI: 10.3390/cancers15041122

Neoadjuvant chemoradiotherapy (neoCRT) followed by surgery is the cornerstone treatment strategy in locally advanced esophageal squamous cell carcinoma (ESCC). Despite this high- intensity multimodality therapy, most patients still experience recurrences and metastases, especially those who do not achieve a pathological complete response (pCR) after neoCRT. Here, we focused on identifying poor prognostic factors. In this retrospective cohort study; we enrolled 140 patients who completed neoCRT plus surgery treatment sequence with no interval metastasis. Overall, 45 of 140 patients (32.1%) achieved a pCR. The overall survival, disease-free survival (DFS), and metastasis-free survival was significantly better in patients with a pCR than in patients with a non-pCR. In the non-pCR subgroup, the presence of perineural invasion (PNI) and preexisting type 2 diabetes (T2DM) were two factors adversely affecting DFS. After adjusting for other factors, multivariate analysis showed that the hazard ratio (HR) was 2.354 (95% confidence interval [CI] 1.240-4.467, = 0.009) for the presence of PNI and 2.368 (95% CI 1.351-4.150, = 0.003) for preexisting T2DM. Patients with a combination of both factors had the worst survival. In conclusion, PNI and preexisting T2DM may adversely affect the prognosis of patients with ESCC receiving neoadjuvant chemoradiotherapy.