Cancer Res Treat.  2022 Oct;54(4):1148-1156. 10.4143/crt.2021.885.

Role of Esophagectomy after Chemoradiation Therapy in Patients with Locally Advanced Squamous Cell Carcinoma: A Comparative Analysis Stratified by Clinical Response to Chemoradiation Therapy

• Yu J
• Kim JH
• Kim SB
• Park SR
• Kim YH
• Kim HR
• Lee HJ
• Song HJ
• Song KJ
• Jang JY
• Jo YY
• Yoo YJ

• KMID: 2534194
• DOI: http://doi.org/10.4143/crt.2021.885

Abstract

Purpose
This study aimed to evaluate the long-term effect of esophagectomy in patients with esophageal squamous cell carcinoma (ESCC) by comparing the chemoradiotherapy (CRT)-only group and the trimodality treatment (TMT) group who received concurrent CRT followed by surgery.
Materials and Methods
We included 412 operable ESCC patients treated with TMT or CRT between January 2005 and December 2015. The oncological outcomes of the two groups were compared using a weighted Cox proportional-hazards model with inverse probability of treatment weighting (IPTW).
Results
The median survival time was 64 and 32 months in the TMT (n=270) and CRT (n=142) groups, respectively (p < 0.001). After IPTW, the median overall survival (OS) remained significantly higher in the TMT group than in the CRT group (61 months vs. 32 months, p=0.016). Moreover, the TMT group showed a better local recurrence-free rate (LRFR, p < 0.001) and distant metastasis-free rate (p=0.007). In the subgroup of patients with clinical complete response (cCR), the OS was not significantly different between the two groups, both before and after IPTW adjustment (p=0.35 and p=0.93). However, among non-cCR patients, the OS was significantly higher in the TMT group (64% vs. 45%, p < 0.001).
Conclusion
In patients with locally advanced ESCC, TMT was superior to CRT in terms of OS and LRFR. Such difference was more prominent in the non-cCR subgroup. In patients who achieved cCR, esophagectomy was effective in improving LRFR but not OS, suggesting that esophagectomy may be omitted in complete responders.

Keyword

Esophageal neoplasms; Squamous cell carcinoma; Chemoradiotherapy; Trimodality treatment; Clinical complete response

Figure

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  Fig. 1 Flow diagram of patient selection. CR, complete response; CRT, chemoradiotherapy; dCRT, definitive chemoradiotherapy; ESCC, esophageal squamous cell carcinoma; nCRT, neoadjuvant chemoradiotherapy; RT, radiotherapy.

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  Fig. 2 Kaplan-Meier survival analysis for overall survival (OS) after inverse probability of treatment weighting adjustment. The OS of the trimodality treatment (TMT) group was significantly better than that of the chemoradiotherapy (CRT) group (p=0.016).

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  Fig. 3 Kaplan-Meier survival analysis for overall survival (A), local recurrence (B), and distant metastasis (C) after inverse probability of treatment weighting adjustment stratified by clinical complete response (cCR) and treatment. (A) In the cCR group, the overall survival of the trimodality treatment (TMT) group was comparable to that of the chemoradiotherapy (CRT) group (p=0.93); in the non-cCR group, the overall survival of the TMT group was significantly better than that of the CRT group (p < 0.001). (B) Local recurrence–free rate of the TMT group was significantly higher than that of the CRT group in both the cCR group (p=0.003) and the non-cCR group (p < 0.001).

Reference

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