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

Annals of Surgical Oncology volume 26, pages 506–513 (2019)Cite this article

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.

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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
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  2. Hui-Shan Chen PhD
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  3. Chia-Chuan Liu MD
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  4. Shiao-Chi Wu PhD
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Corresponding author

Correspondence to Po-Kuei Hsu MD.

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The authors declare no conflicts of interest.

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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

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

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