Medical Oncology

, 33:31 | Cite as

The role of postoperative adjuvant chemotherapy for lymph node-positive esophageal squamous cell carcinoma: a propensity score matching analysis

  • Rong-Qing Qin
  • Ying-Sheng Wen
  • Wu-ping Wang
  • Ke-Xing Xi
  • Xiang-Yang Yu
  • Lan-Jun ZhangEmail author
Original Paper


The prognosis of patients with lymph node-positive esophageal squamous cell carcinoma (ESCC) who primarily receive radical esophagectomy remains poor. In this study, we aimed to retrospectively investigate the role of postoperative adjuvant chemotherapy with docetaxel- or paclitaxel-based regimens in these patients. A total of 434 consecutive patients were included in this study who underwent radical esophagectomy and were pathologically confirmed to have lymph node-positive ESCC from January 2005 to December 2010 in our institution. Among these patients, 113 patients received postoperative adjuvant chemotherapy (Group SC), and 321 patients underwent surgery alone (Group S). Propensity score matching and multivariate analyses were used to compensate for differences in some baseline characteristics. After matching, Group SC had significantly longer median disease-free survival (DFS) than that in Group S (23.63 months vs. 16.70 months; p = 0.006); further subset analysis revealed that a benefit regarding DFS was only associated with patients with N1 stage and with tumor length <4.5 cm. The median overall survival (OS) was similar between the two groups (38.57 months for Group SC vs. 25.27 months for Group S; p = 0.05). Multivariate analysis showed that postoperative chemotherapy, length of the tumor, T status, and N category were significantly independent predictive factors of tumor recurrence (p < 0.05). Our data suggested that adjuvant chemotherapy with docetaxel- or paclitaxel-based regimens could significantly improve DFS for patients with N1 stage and tumor length <4.5 cm ESCC and that it could potentially prolong OS for patients with lymph node-positive ESCC after surgery, compared with surgery alone. These results warrant further confirmation in prospective, randomized trials.


Esophageal squamous cell carcinoma Lymph node-positive Postoperative adjuvant chemotherapy Prognosis 



Esophageal squamous cell carcinoma


Disease-free survival


Overall survival


National Comprehensive Cancer Network


Computed tomography


Positron emission tomography


American Joint Committee on Cancer




Minimally invasive esophagectomy


Hazard ratio


Confidence interval



We would like to thank Xing-Xuan Wen, MD, for performing the propensity score matching analysis. This research was supported by grants from the National High Technology Research and Development Program of China (No. 2012AA02A503).

Compliance with ethical standards

Conflicts of interest

The authors have no conflicts of interest to disclose.


  1. 1.
    Wu PC, Posner MC. The role of surgery in the management of oesophageal cancer. Lancet Oncol. 2003;4(8):481–8.CrossRefPubMedGoogle Scholar
  2. 2.
    Worni M, et al. Does surgery improve outcomes for esophageal squamous cell carcinoma? An analysis using the surveillance epidemiology and end results registry from 1998 to 2008. J Am Coll Surg. 2012;215(5):643–51.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Nakagawa S, et al. Recurrence pattern of squamous cell carcinoma of the thoracic esophagus after extended radical esophagectomy with three-field lymphadenectomy. J Am Coll Surg. 2004;198(2):205–11.CrossRefPubMedGoogle Scholar
  4. 4.
    Rustgi AK, El-Serag HB. Esophageal carcinoma. N Engl J Med. 2014;371(26):2499–509.CrossRefPubMedGoogle Scholar
  5. 5.
    Ando N, et al. Surgery plus chemotherapy compared with surgery alone for localized squamous cell carcinoma of the thoracic esophagus: a Japan Clinical Oncology Group Study–JCOG9204. J Clin Oncol. 2003;21(24):4592–6.CrossRefPubMedGoogle Scholar
  6. 6.
    Lee J, et al. Adjuvant chemotherapy with 5-fluorouracil and cisplatin in lymph node-positive thoracic esophageal squamous cell carcinoma. Ann Thorac Surg. 2005;80(4):1170–5.CrossRefPubMedGoogle Scholar
  7. 7.
    Ando N, Iizuka T, Kakegawa T, Isono K, Watanabe H, Ide H, Tanaka O, Shinoda M, Takiyama W, Arimori M, Ishida K, Tsugane S. A randomized trial of surgery with and without chemotherapy for localized squamous carcinoma of the thoracic esophagus: the Japan Clinical Oncology Group Study. J Thorac Cardiovasc Surg. 1997;114(2):205–9.CrossRefPubMedGoogle Scholar
  8. 8.
    Pasquer A, et al. Impact of adjuvant chemotherapy on patients with lymph node-positive esophageal cancer who are primarily treated with surgery. Ann Surg Oncol. 2015;22:S1340–9.CrossRefGoogle Scholar
  9. 9.
    Chen H, et al. Postoperative adjuvant therapy for resectable thoracic esophageal squamous cell carcinoma: a retrospective analysis of 426 cases. Med Oncol. 2014;32(1):417.CrossRefPubMedGoogle Scholar
  10. 10.
    Rice TW, Blackstone EH, Rusch VW. 7th edition of the AJCC cancer staging manual: esophagus and esophagogastric junction. Ann Surg Oncol. 2010;17(7):1721–4.CrossRefPubMedGoogle Scholar
  11. 11.
    Smalley SR, et al. Updated analysis of SWOG-directed intergroup study 0116: a phase III trial of adjuvant radiochemotherapy versus observation after curative gastric cancer resection. J Clin Oncol. 2012;30(19):2327–33.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Lyu X, et al. Adjuvant chemotherapy after esophagectomy: is there a role in the treatment of the lymph node positive thoracic esophageal squamous cell carcinoma? J Surg Oncol. 2014;110(7):864–8.CrossRefPubMedGoogle Scholar
  13. 13.
    Zhang SS, et al. Adjuvant chemotherapy versus surgery alone for esophageal squamous cell carcinoma: a meta-analysis of randomized controlled trials and nonrandomized studies. Dis Esophagus. 2014;27(6):574–84.CrossRefPubMedGoogle Scholar
  14. 14.
    Yendamuri S, et al. Esophageal tumor length is independently associated with long-term survival. Cancer. 2009;115(3):508–16.CrossRefPubMedGoogle Scholar
  15. 15.
    Wang BY, et al. Endoscopic tumor length is an independent prognostic factor in esophageal squamous cell carcinoma. Ann Surg Oncol. 2012;19(7):2149–58.CrossRefPubMedGoogle Scholar
  16. 16.
    Xiao ZF, et al. Influence of number of metastatic lymph nodes on survival of curative resected thoracic esophageal cancer patients and value of radiotherapy: report of 549 cases. Int J Radiat Oncol Biol Phys. 2005;62(1):82–90.CrossRefPubMedGoogle Scholar
  17. 17.
    Chen J, et al. Postoperative radiation therapy with or without concurrent chemotherapy for node-positive thoracic esophageal squamous cell carcinoma. Int J Radiat Oncol Biol Phys. 2013;86(4):671–7.CrossRefPubMedGoogle Scholar
  18. 18.
    BédardEL IR, Malthaner RA, Brecevic E, Vincent M, Dar R. The role of surgery and postoperative chemoradiation therapy in patients with lymph node positive esophageal carcinoma. Cancer. 2001;91(12):2423–30.CrossRefGoogle Scholar
  19. 19.
    Hsu PK, et al. Survival benefits of postoperative chemoradiation for lymph node-positive esophageal squamous cell carcinoma. Ann Thorac Surg. 2014;97(5):1734–41.CrossRefPubMedGoogle Scholar
  20. 20.
    Ando N, et al. A randomized trial comparing postoperative adjuvant chemotherapy with cisplatin and 5-fluorouracil versus preoperative chemotherapy for localized advanced squamous cell carcinoma of the thoracic esophagus (JCOG9907). Ann Surg Oncol. 2012;19(1):68–74.CrossRefPubMedGoogle Scholar
  21. 21.
    Cortes JE, Pazdur R. Docetaxel. J Clin Oncol. 1995;13(10):2643–55.PubMedGoogle Scholar
  22. 22.
    Choy H. Combining taxanes with radiation for solid tumors. Int J Cancer. 2000;90(3):113–27.CrossRefPubMedGoogle Scholar
  23. 23.
    Yoshioka T, et al. Dose escalation study of docetaxel and nedaplatin in patients with relapsed or refractory squamous cell carcinoma of the esophagus pretreated using cisplatin, 5-fluorouracil, and radiation. Int J Clin Oncol. 2006;11(6):454–60.CrossRefPubMedGoogle Scholar
  24. 24.
    Li X, et al. Phase II trial of second-line chemotherapy with docetaxel and capecitabine in advanced esophageal squamous cell carcinoma. Med Oncol. 2013;30(4):746.CrossRefPubMedGoogle Scholar
  25. 25.
    Shirakawa T, et al. A retrospective study of docetaxel or paclitaxel in patients with advanced or recurrent esophageal squamous cell carcinoma who previously received fluoropyrimidine- and platinum-based chemotherapy. Cancer Chemother Pharmacol. 2014;74(6):1207–15.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Rong-Qing Qin
    • 1
    • 2
  • Ying-Sheng Wen
    • 1
    • 2
  • Wu-ping Wang
    • 3
  • Ke-Xing Xi
    • 1
    • 2
  • Xiang-Yang Yu
    • 1
    • 2
  • Lan-Jun Zhang
    • 1
    • 2
    Email author
  1. 1.Department of Thoracic SurgerySun Yat-sen University Cancer CenterGuangzhouPeople’s Republic of China
  2. 2.State Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer MedicineGuangzhouPeople’s Republic of China
  3. 3.Department of Thoracic Surgery, Tangdu Hospitalthe Fourth Military Medical UniversityXi’anPeople’s Republic of China

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