Prognostic Impact of Squamous Cell Carcinoma Antigen During Neoadjuvant Chemotherapy for Patients With Esophageal Squamous Cell Carcinoma Treated With Minimally Invasive Esophagectomy

Abstract

Background/aim: Squamous cell carcinoma antigen (SCC) is widely used as a tumor marker for esophageal cancer. In this study, we investigated the relationship between SCC and long-term outcomes in patients with esophageal squamous cell carcinoma after neoadjuvant chemotherapy (NAC) followed by minimally invasive esophagectomy (MIE).

Patients and methods: Between 2010 and 2018, 124 patients with ESCC who underwent MIE after NAC (cisplatin plus 5-fluorouracil) were included. Patients were divided into low and high groups based on their pre-NAC SCC level, according to the cut-off value determined using a receiver operating characteristic curve. These two patient groups were further divided into subgroups by receiver operating characteristics according to whether SCC was low or high after NAC.

Results: For overall survival (OS), the cut-off value for SCC pre-NAC was 0.9 ng/ml. Ninety-six patients were in the high SCC group (≥0.9 ng/ml) and 28 patients were in the low SCC group (<0.9 ng/ml) prior to NAC. The patients were then divided into pre-NAC/post-NAC SCC subgroups accordingly: low/low SCC (n=7), low/high SCC (n=21), high/low SCC (n=53), and high/high SCC (n=43). The 5-year OS rates were 100%, 66.7%, 50.9%, and 32.6%, respectively. In the multivariate analysis for OS, a high/high pre-NAC/post-NAC SCC status was an independent prognostic factor for poorer OS, along with pathological N stage.

Conclusion: For patients with esophageal squamous cell carcinoma treated with NAC followed by MIE, a high SCC level prior to NAC which was also high after NAC was an independent prognostic factor and might contribute to deciding the need for adjuvant therapy.

Keywords: Esophageal squamous cell carcinoma; minimally invasive esophagectomy; neoadjuvant chemotherapy; squamous cell carcinoma antigen; tumor marker.