Survival Comparison Among Neoadjuvant Chemoradiotherapy Followed by Esophagectomy, Definitive Chemoradiotherapy, and Esophagectomy Alone for Esophageal Squamous Cell Carcinoma.
Chemoradiotherapy
Esophageal squamous cell carcinoma
Esophagectomy
Journal
Annals of surgical oncology
ISSN: 1534-4681
Titre abrégé: Ann Surg Oncol
Pays: United States
ID NLM: 9420840
Informations de publication
Date de publication:
Jun 2022
Jun 2022
Historique:
received:
07
09
2021
accepted:
17
11
2021
pubmed:
8
1
2022
medline:
11
5
2022
entrez:
7
1
2022
Statut:
ppublish
Résumé
For patients with locoregional esophageal squamous cell carcinoma (ESCC), survival outcomes among neoadjuvant chemoradiotherapy followed by operation (nCRT-OP), definitive chemoradiotherapy (dCRT), and esophagectomy alone remain controversial. Information from the 2008-2016 Taiwan Cancer Registry was used. A total of 7637 cT1b-4, N0/+, M0 ESCC patients receiving nCRT-OP (n = 1955), dCRT (n = 4122), or esophagectomy alone (n = 1560) were included. Propensity score matching was performed to balance clinical variables among the three groups. Stage-specific overall survival was compared before and after propensity score matching. Univariable and multivariable analyses were performed to identify prognostic factors. Propensity score matching resulted in 1407 cases for comparison. The 5-year overall survival rates for matched patients treated via dCRT, nCRT-OP, and esophagectomy alone were 19.77%, 31.23%, and 30.52%, respectively (p < 0.001). On multivariable analysis, treatment modality was still an independent prognostic factor both before and after propensity score matching. nCRT-OP and esophagectomy alone were associated with significantly better overall survival than dCRT for locoregional ESCC patients. This propensity-matched study revealed that nCRT-OP and esophagectomy provided better survival than dCRT in cT1b-4, N0/+, M0 ESCC patients.
Sections du résumé
BACKGROUND
BACKGROUND
For patients with locoregional esophageal squamous cell carcinoma (ESCC), survival outcomes among neoadjuvant chemoradiotherapy followed by operation (nCRT-OP), definitive chemoradiotherapy (dCRT), and esophagectomy alone remain controversial.
PATIENTS AND METHODS
METHODS
Information from the 2008-2016 Taiwan Cancer Registry was used. A total of 7637 cT1b-4, N0/+, M0 ESCC patients receiving nCRT-OP (n = 1955), dCRT (n = 4122), or esophagectomy alone (n = 1560) were included. Propensity score matching was performed to balance clinical variables among the three groups. Stage-specific overall survival was compared before and after propensity score matching. Univariable and multivariable analyses were performed to identify prognostic factors.
RESULTS
RESULTS
Propensity score matching resulted in 1407 cases for comparison. The 5-year overall survival rates for matched patients treated via dCRT, nCRT-OP, and esophagectomy alone were 19.77%, 31.23%, and 30.52%, respectively (p < 0.001). On multivariable analysis, treatment modality was still an independent prognostic factor both before and after propensity score matching. nCRT-OP and esophagectomy alone were associated with significantly better overall survival than dCRT for locoregional ESCC patients.
CONCLUSIONS
CONCLUSIONS
This propensity-matched study revealed that nCRT-OP and esophagectomy provided better survival than dCRT in cT1b-4, N0/+, M0 ESCC patients.
Identifiants
pubmed: 34994899
doi: 10.1245/s10434-021-11210-8
pii: 10.1245/s10434-021-11210-8
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
3617-3627Informations de copyright
© 2021. Society of Surgical Oncology.
Références
Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68:394–424.
doi: 10.3322/caac.21492
Ajani JA, Damico TA, Bentrem DJ, et al. Esophageal and esophagogastric junction cancers, version 2.2019, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw. 2019;17:855–83.
doi: 10.6004/jnccn.2019.0033
Shah MA, Kennedy EB, Catenacci DV, et al. Treatment of locally advanced esophageal carcinoma: ASCO guideline. J Clin Oncol. 2020;38:2677–94.
doi: 10.1200/JCO.20.00866
Chavez-MacGregor M, Giordano SH. Randomized clinical trials and observational studies: is there a battle? J Clin Oncol. 2016;34:772–3.
doi: 10.1200/JCO.2015.64.7487
van Hagen P, Hulshof MCCM, van Lanschot JJB, et al. Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med. 2012;366:2074–84.
doi: 10.1056/NEJMoa1112088
Shapiro J, van Lanschot JJB, Hulshof MCCM, et al. Neoadjuvant chemoradiotherapy plus surgery versus surgery alone for oesophageal or junctional cancer (CROSS): long-term results of a randomised controlled trial. Lancet Oncol. 2015;16:1090–8.
doi: 10.1016/S1470-2045(15)00040-6
Sjoquist KM, Burmeister BH, Smithers BM, et al. Survival after neoadjuvant chemotherapy or chemoradiotherapy for resectable oesophageal carcinoma: an updated meta-analysis. Lancet Oncol. 2011;12:681–92.
doi: 10.1016/S1470-2045(11)70142-5
Mariette C, Dahan 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;32:2416–22.
doi: 10.1200/JCO.2013.53.6532
Yang H, Liu H, Chen Y, et al. Neoadjuvant chemoradiotherapy followed by surgery versus surgery alone for locally advanced squamous cell carcinoma of the esophagus (NEOCRTEC5010): a phase III multicenter, randomized, open-label clinical trial. J Clin Oncol. 2018;36:2796–803.
doi: 10.1200/JCO.2018.79.1483
Herskovic A, Martz K, Al-Sarraf M, et al. Combined chemotherapy and radiotherapy compared with radiotherapy alone in patients with cancer of the esophagus. N Engl J Med. 1992;326:1593–8.
doi: 10.1056/NEJM199206113262403
Minsky BD, Pajak TF, Ginsberg RJ, et al. INT 0123 (Radiation Therapy Oncology Group 94-05) phase III trial of combined-modality therapy for esophageal cancer: high-dose versus standard-dose radiation therapy. J Clin Onjlmcol. 2002;20:1167–74.
doi: 10.1200/JCO.2002.20.5.1167
Mikhail S, Wei L, Salem ME, et al. Outcomes of definitive chemoradiation in patients with esophageal cancer. Dis Esophagus. 2017;30:1–7.
pubmed: 28881909
Teoh AY, Chiu PW, Yeung WK, Liu SY, Wong SK, Ng EK. Long-term survival outcomes after definitive chemoradiation versus surgery in patients with resectable squamous carcinoma of the esophagus: results from a randomized controlled trial. Ann Oncol. 2013;24:165–71.
doi: 10.1093/annonc/mds206
Chiu PW, Chan AC, Leung SF, et al. Multicenter prospective randomized trial comparing standard esophagectomy with chemoradiotherapy for treatment of squamous esophageal cancer: early results from the Chinese University Research Group for Esophageal Cancer (CURE). J Gastrointest Surg. 2005;9:794–802.
doi: 10.1016/j.gassur.2005.05.005
Pottgen C, Stuschke M. Radiotherapy versus surgery within multimodality protocols for esophageal cancer—a meta-analysis of the randomized trials. Cancer Treat Rev. 2012;38:599–604.
doi: 10.1016/j.ctrv.2011.10.005
Liu S, Qiu B, Luo G, et al. TNM Staging Matched-pair Comparison of surgery after neoadjuvant chemoradiotherapy, surgery alone and definitive chemoradiotherapy for thoracic esophageal squamous cell carcinoma. J Cancer. 2017;8:683–90.
doi: 10.7150/jca.17048
Lin WC, Ding YF, Hsu HL, et al. Value and application of trimodality therapy or definitive concurrent chemoradiotherapy in thoracic esophageal squamous cell carcinoma. Cancer. 2017;123:3904–15.
doi: 10.1002/cncr.30823
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.
doi: 10.1093/jjco/hyu211
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.
Hsu PK, Chen HS, Liu CC, et al. Application of the eighth AJCC TNM staging system in patients with esophageal squamous cell carcinoma. Ann Thorac Surg. 2018;105(5):1516–22.
doi: 10.1016/j.athoracsur.2017.12.032
Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–83.
doi: 10.1016/0021-9681(87)90171-8
Jang R, Darling G, Wong RK. Multimodality approaches for the curative treatment of esophageal cancer. J Natl Compr Canc Netw. 2015;13:229–38.
doi: 10.6004/jnccn.2015.0029
Hsu PK, Chen HS, Liu CC, Wu SC. Neoadjuvant chemoradiation versus upfront esophagectomy in clinical stage II and III esophageal squamous cell carcinoma. Ann Surg Oncol. 2019;26:506–13.
doi: 10.1245/s10434-018-7060-y
Karran A, Blake P, Chan D, et al. Propensity score analysis of oesophageal cancer treatment with surgery or definitive chemoradiotherapy. Br J Surg. 2014;101:502–10.
doi: 10.1002/bjs.9437
Wang BY, Hung WH, Wu SC, et al. Comparison between esophagectomy and definitive chemoradiotherapy in patients with esophageal cancer. Ann Thorac Surg. 2019;107:1060–7.
doi: 10.1016/j.athoracsur.2018.11.036
Stahl M, Stuschke M, Lehmann N, et al. Chemoradiation with and without surgery in patients with locally advanced squamous cell carcinoma of the esophagus. J Clin Oncol. 2005;23:2310–7.
doi: 10.1200/JCO.2005.00.034
Bedenne L, Michel P, Bouche O, et al. Chemoradiation followed by surgery compared with chemoradiation alone in squamous cancer of the esophagus: FFCD 9102. J Clin Oncol. 2007;25:1160–8.
doi: 10.1200/JCO.2005.04.7118
Naik KB, Liu Y, Goodman M, et al. Concurrent chemoradiotherapy with or without surgery for patients with resectable esophageal cancer: an analysis of the National Cancer Data Base. Cancer. 2017;123:3476–85.
doi: 10.1002/cncr.30763
McKenzie S, Mailey B, Artinyan A, et al. Improved outcomes in the management of esophageal cancer with the addition of surgical resection to chemoradiation therapy. Ann Surg Oncol. 2011;18:551–8.
doi: 10.1245/s10434-010-1314-7
Hategan M, Cook N, Prewett S, et al. Trimodality therapy and definitive chemoradiotherapy for esophageal cancer: a single-center experience and review of the literature. Dis Esophagus. 2015;28:612–8.
doi: 10.1111/dote.12242
Wang BY, Wu SC, Chen HC, et al. Survival after neoadjuvant chemoradiotherapy and oesophagectomy versus definitive chemoradiotherapy for patients with oesophageal squamous cell carcinoma. Br J Surg. 2018;106:255–62.
doi: 10.1002/bjs.11004
Chen HS, Hung WH, Ko JL, et al. Impact of treatment modalities on survival of patients with locoregional esophageal squamous-cell carcinoma in Taiwan. Medicine. 2016;95:e3018.
doi: 10.1097/MD.0000000000003018
Chen MF, Yang YH, Lai CH, et al. Outcome of patients with esophageal cancer: a nationwide analysis. Ann Surg Oncol. 2013;20:3023–30.
doi: 10.1245/s10434-013-2935-4
Wang BY, Lin PY, Wu SC, et al. Comparison of pathologic stage in patients receiving esophagectomy with and without preoperative chemoradiation therapy for esophageal SCC. J Natl Compr Canc Netw. 2014;12:1697–705.
doi: 10.6004/jnccn.2014.0171
Rice TW, Apperson-Hansen C, DiPaola LM, et al. Worldwide Esophageal Cancer Collaboration: clinical staging data. Dis Esophagus. 2016;29:707–14.
doi: 10.1111/dote.12493
Cooper JS, Guo MD, Herskovic A, et al. Chemoradiotherapy of locally advanced esophageal cancer: long-term follow-up of a prospective randomized trial (RTOG 85-01). Radiation Therapy Oncology Group. JAMA. 1999;281:1623–7.
doi: 10.1001/jama.281.17.1623
Honing J, Smit JK, Muijs CT, et al. A comparison of carboplatin and paclitaxel with cisplatinum and 5-fluorouracil in definitive chemoradiation in esophageal cancer patients. Ann Oncol. 2014;25(3):638–43.
doi: 10.1093/annonc/mdt589
Faiz Z, Plukker JTM. ASO Author Reflections: implementation of age and co-morbidity in the treatment guideline of patients with esophageal squamous cell carcinoma. Ann Surg Oncol. 2019;26:585–6.
doi: 10.1245/s10434-019-07361-4