The role of adjuvant chemotherapy in esophageal cancer patients after neoadjuvant chemotherapy plus surgery.

Background Esophageal cancer typically has a poor prognosis. While neoadjuvant chemotherapy (NAC) is reported to be effective for esophageal cancer patients, the prognosis of patients for whom NAC is ineffective remains poor. Methods In total, 113 patients with thoracic esophageal squamous cell carcinoma who were treated between January 2006 and December 2015 were enrolled. These patients received NAC followed by radical surgery and had three or more pathologic positive lymph nodes. The effectiveness and feasibility of adjuvant chemotherapy (AC) were evaluated. Results Forty patients received AC (AC(+) group) and 73 patients did not (AC(-) group). Two-year relapse-free survival (RFS) rates of the AC(+) and AC(-) groups were 30.0% and 28.8%, respectively (p = 0.47). These patients were further divided into two subgroups, i.e., those with 3-6 positive lymph nodes (3-6 subgroup) and those with ≥ 7 positive lymph nodes (≥ 7 subgroup). Within the 3-6 subgroup (72 patients), 2-year RFS rates of the AC(+) and AC(-) groups were 38.5% and 33.9%, respectively (p = 0.31). Within the ≥ 7 subgroup (41 patients), 2-year RFS rates of the AC(+) and AC(-) groups were 25.9% and 7.1%, respectively (p = 0.04). Conclusions AC may offer a significant additional benefit to the prognosis of esophageal cancer patients who have many positive lymph nodes even after NAC.