PROGNOSTIC FACTORS IN OESOPHAGEAL CANCER PATIENTS TREATED BY PREOPERATIVE CONCURRENT CHEMORADIOTHERAPY AND SURGERY

Konference: 2006 31st Congress ESMO - účast ČR

Kategorie: Gastrointestinální nádory

Téma: Upper gastrointestinal tumors

Číslo abstraktu: 1123P

Autoři: Doc. MUDr. Milada Zemanová, Ph.D.; MUDr. Gabriela Pazdrová; MUDr. František Novák, Ph.D.; Alexandr Pazdro; Prof. Martin Haluzík, DrSc.; Milan Smejkal; prof. MUDr. Luboš Petruželka, CSc.

Combined modality therapy in oesophageal cancer patients is suggested to prolong survival at the cost of higher toxicity. In this study we analyze various factors to establish prognostic factors for treatment outcome. 107 patients (pts), 93 men, 14 women, with operable oesophageal cancer were treated by neoadjuvant chemoradiotherapy (CRT) using CF regimen for 65 pts (61%) (carboplatin, AUC 6, IV on days 1 and 22, 5-fluorouracil, 300 mg/day, continuous infusion (CI) on days 1 to 42), or CPF regimen (CF plus paclitaxel 200 mg/m2/3hours IV on days 1 and 22) for 42 pts (39%) plus radiotherapy 45 Gy/25fr/5 weeks starting on day 1. Nutritional support was offered to all pts. Surgery was performed within 4-8 weeks after CRT if feasible. The influence of various clinical, laboratory, treatment and nutritional variables on survival was tested by univariate analysis with consecutive multivariate analysis of following
factors: N-stage, performance status (PS), localization of stenosis, grade of dysphagia, relative pre-treatment weight loss, pathological complete response (pCR), pretreatment serum levels of albumin, prealbumin, leptin, soluble leptin receptor (SLR) and tumour necrosis factor alpha (TNF-a). Median survival 20.0 months and 3-year survival of 32% was determined. Treatment with CF or CPF regimens did not differ significantly (p=0.512). Significant factors positively influencing survival in univariate analysis were: PS (0 vs. 1-2, p=0.012), grade of dysphagia (mild vs. serious, p=0.001), TNF-a level (lower vs. higher, p=0.028), pCR (yes vs. not, p=0.036). Other variables mentioned above were included to multivariate analysis due to trend in univariate one (p<0.2). Two independent factors influencing survival were found out in multivariate analysis: grade of dysphagia (mild vs. serious, p=0.017) and SLR (lower vs. higher, p=0.049). PS (0 vs. 1-2) had borderline significance of p=0.062.
Conclusions: Pre-treatment serum level of SLR and grade of dysphagia were found out to be independent survival prognostic factors in this study of multimodal treatment of oesophageal cancer. Values of leptin, SLR and TNF-a need further prospective follow-up.
Supported by grant IGA MZ CR 7530-3.

Datum přednesení příspěvku: 29. 6. 2006