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.