Skip to main content

Advertisement

SpringerLink
Log in

Neoadjuvant Chemoradiation Versus Upfront Esophagectomy in Clinical Stage II and III Esophageal Squamous Cell Carcinoma

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The benefits of neoadjuvant chemoradiation (NCRT) compared to upfront esophagectomy (UE) in esophageal squamous cell carcinoma (ESCC) is controversial. Our purpose was to determine whether clinical stages based on the 8th edition American Joint Committee on Cancer Tumor-Node-Metastasis staging system could guide treatment decision.

Methods

Data from 2503 patients with clinical stages II and III ESCC diagnosed between 2008 and 2014 were obtained from a nationwide database. Propensity score matching was used to identify well-balanced pairs of patients. Cox proportional hazards regression and log-rank test were used in the survival analysis. The outcomes of patients receiving “NCRT followed by surgery” or “UE” strategies were compared.

Results

The treatment modality (UE or NCRT) was not a prognostic factor in clinical stage II ESCC (HR: 0.97; p = 0.778). In contrast, the UE group demonstrated a significantly worse outcome compared with the NCRT group in clinical stage III ESCC (HR: 1.39; p < 0.001). After matching, patients who underwent UE for clinical stage II ESCC had median survival/3-year overall survival (OS) rates of 27.8 months/39.2% compared with 32.7 months/49.8% in the NCRT group (p = 0.508). The patients who underwent UE for clinical stage III ESCC had median survival/3-year OS rates of 17.9 months/28.2% in the UE group compared with 24.0 months/41.8% in the NCRT group (p < 0.001).

Conclusions

Our data suggest that NCRT strategy improved survival compared with UE in clinical stage III ESCC but not in clinical stage II tumors.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Rustgi AK, El-Serag HB. Esophageal carcinoma. N Engl J Med. 2014;371:2499–509.

    Article  CAS  PubMed  Google Scholar 

  2. Jang R, Darling G, Wong RK. Multimodality approaches for the curative treatment of esophageal cancer. J Natl Compr Canc Netw. 2015;13:229–38.

    Article  CAS  PubMed  Google Scholar 

  3. Van Hagen P, Hulshof MC, van Lanschot JJ, et al. Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med. 2012;366:2074–84.

    Article  PubMed  Google Scholar 

  4. Mariette C, Dohan L, Mornex F, et al. Surgery alone versus chemoradiotherapy followed by surgery for stage I and II esophageal cancer: final analysis of randomized controlled phase III trial FFCD 9901. J Clin Oncol. 2014;10:2416–22.

    Article  CAS  Google Scholar 

  5. Speicher PJ, Ganapathi AM, Englum BR, et al. Induction therapy does not improve survival for clinical stage T2N0 esophageal cancer. J Thorac Oncol. 2014;9:1195–201.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Markar SR, Gronnier C, Pasquer A, et al. Role of neoadjuvant treatment in clinical T2N0M0 oesophageal cancer: results from a retrospective multi-center European study. Eur J Cancer. 2016;56:59–68.

    Article  CAS  PubMed  Google Scholar 

  7. Zahoor H, Luketich JD, Levy RM, et al. A propensity-matched analysis comparing survival after primary minimally invasive esophagectomy followed by adjuvant therapy to neoadjuvant therapy for esophagogastric adenocarcinoma. J Thorac Cardiovasc Surg. 2015;149:538–47.

    Article  PubMed  Google Scholar 

  8. Matsuda S, Tsubosa Y, Sato H, et al. Comparison of neoadjuvant chemotherapy versus upfront surgery with or without chemotherapy for patients with clinical stage III esophageal squamous cell carcinoma. Dis Esophagus. 2017;30:1–8.

    Article  CAS  PubMed  Google Scholar 

  9. Hwang JY, Chen HS, Hsu PK, et al. A propensity-matched analysis comparing survival after esophagectomy followed by adjuvant chemoradiation to surgery alone for esophageal squamous cell carcinoma. Ann Surg. 2016;264:100–6.

    Article  PubMed  Google Scholar 

  10. Hsu PK, Chen HS, Huang CS, et al. Patterns of recurrence after oesophagectomy and postoperative chemoradiotherapy versus surgery alone for oesophageal squamous cell carcinoma. Br J Surg. 2017;104:90–7.

    Article  CAS  PubMed  Google Scholar 

  11. Hsu PK, Chen HS, Liu CC, et al. Pre- versus postoperative chemoradiotherapy for locally advanced esophageal squamous cell carcinoma. J Thorac Cardiovasc Surg. 2017;154:732–40.

    Article  PubMed  Google Scholar 

  12. Chiang CJ, You SL, Chen CJ, et al. Quality assessment and improvement of nationwide cancer registration system in Taiwan: a review. Jpn J Clin Oncol. 2015;45:291–6.

    Article  PubMed  Google Scholar 

  13. Rice TW, Ishwaran H, Ferguson MK, et al. Cancer of the esophagus and esophagogastric junction: an eighth edition staging primer. J Thorac Oncol. 2017;12:36–42.

  14. Chen HS, Hsu PK, Liu CC, Wu SC. Upfront surgery and pathological stage-based adjuvant chemoradiation strategy in locally advanced esophageal squamous cell carcinoma. Sci Rep. 2018;8:2180.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Liu TW, Hung YN, Earle CC, et al. Characteristics and correlates of increasing use of surgery in Taiwanese cancer patients’ last month of life, 2001–2010. Ann Surg. 2016;264:283–90.

    Article  PubMed  Google Scholar 

Download references

Author information

Author notes

  1. Po-Kuei Hsu and Hui-Shan Chen contributed equally to this study.

Authors and Affiliations

  1. Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital and School of Medicine, National Yang-Ming University, Taipei, Taiwan

    Po-Kuei Hsu MD

  2. Department of Health Care Administration, College of Health Sciences, Chang Jung Christian University, Tainan, Taiwan

    Hui-Shan Chen PhD

  3. Division of Thoracic Surgery, Department of Surgery, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan

    Chia-Chuan Liu MD

  4. Institute of Health and Welfare Policy, National Yang-Ming University, Taipei, Taiwan

    Shiao-Chi Wu PhD

Authors
  1. Po-Kuei Hsu MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hui-Shan Chen PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Chia-Chuan Liu MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Shiao-Chi Wu PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Po-Kuei Hsu MD.

Ethics declarations

Disclosure

The authors declare no conflicts of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hsu, PK., Chen, HS., Liu, CC. et al. Neoadjuvant Chemoradiation Versus Upfront Esophagectomy in Clinical Stage II and III Esophageal Squamous Cell Carcinoma. Ann Surg Oncol 26, 506–513 (2019). https://doi.org/10.1245/s10434-018-7060-y

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-018-7060-y

Keywords

Search

Navigation