Clinical advantages of two vs. three courses of neoadjuvant chemotherapy using docetaxel + cisplatin + 5-fluorouracil to improve preoperative nutritional status and mitigate decreasing skeletal muscle in resectable esophageal cancer.

PURPOSE: Neoadjuvant chemotherapy (NAC) using docetaxel/cisplatin/5-fluorouracil (DCF) for locally advanced esophageal cancer (EC) showed better clinical outcomes than conventional regimens; however, had high incidence of serious adverse events.

METHODS

Patients who underwent radical esophagectomy after neoadjuvant-DCF were classified into two-course and three-course groups (n = 60 and 41). Multiple clinical indicators related to nutrition and skeletal muscle that were reported to be associated with survival outcomes were compared between the two groups.

RESULTS

Changes in prognostic nutritional index (PNI), geriatric nutritional risk index (GNRI), and psoas muscle area (PMA) were significantly low in the three-course group (p < 0.001, < 0.001, and = 0.003). Multivariate analyses for PNI change rate showed initial PNI < 45 and three-course DCF as independent associated factors (B = 0.129; p < 0.001 and B =  - 0.057; p = 0.022); GNRI change rate showed body mass index ≥ 21, initial PNI < 45, and three-course DCF as independent associated factors (B =  - 0.033; p < 0.001, B = 0.062; p < 0.001, and B =  - 0.059; p < 0.001); PMA change rate showed three-course DCF and cStage IV as independent associated factors (B =  - 0.024; p = 0.011 and B =  - 0.025; p = 0.038). There were not significant differences in the long-term survivals between the two groups in pStages I-IV.

CONCLUSIONS

Two courses were superior to three courses for improving nutritional status and mitigating skeletal muscle decreasing during NAC-DCF for EC.