Impact of Neoadjuvant Docetaxel, Cisplatin, and 5-Fluorouracil-induced Neutropenia on Histological Tumor Response in Esophageal Squamous Cell Carcinoma: A Retrospective Study.

INTRODUCTION:We investigated the relationship between neoadjuvant docetaxel, cisplatin, and 5-fluorouracil (DCF) chemotherapy-induced neutropenia and histological tumor response or prognosis to support appropriate postoperative treatment selection in patients with esophageal cancer receiving neoadjuvant DCF. METHODS:Patients with esophageal cancer who underwent neoadjuvant DCF followed by surgery at Showa Medical University Hospital, Japan were retrospectively analyzed. A Cox proportional hazards regression analysis including prognostic factors (chemotherapy-induced neutropenia) was performed to determine progression-free survival (PFS). Survival curves for the histological tumor response grades 0-1b and 2-3, stratified by neutropenia severity, were estimated by Kaplan-Meier analysis, and compared using the log-rank test. RESULTS:Among 53 patients (median age, 66 years [range: 48-78]; median PFS, 21 months), 33 (62.2 %) had clinical stage (cStage) IV disease, and 36 (67.9%) had grade 3/4 neutropenia. Multivariate analysis showed that cStage IVb (hazard ratio [HR]: 3.46, P = 0.004) and histological tumor response grade 0-1b (HR: 6.09, P < 0.001) were independent poor prognostic factors for PFS. In the grade 3/4 neutropenia group, a lower histological tumor response was associated with shorter PFS (median PFS: grade 0-1b, 10.1 months vs. grade 2-3, not reached, P < 0.001). CONCLUSIONS:In this study, cStage IVb and histological tumor response grade 0-1b were poor prognostic factors for PFS in patients with esophageal cancer who received neoadjuvant DCF followed by surgery. The histological tumor response was associated with PFS in patients with grade 3/4 neutropenia.