Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China.
Department of Esophageal Cancer, Tianjin's Clinical Research Center for Cancer and Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.
Thorac Cancer. 2020 Sep;11(9):2618-2629. doi: 10.1111/1759-7714.13586. Epub 2020 Aug 4.
The impact of neoadjuvant chemoradiotherapy (nCRT) on early stage esophageal cancer is unknown. Here, we compared the outcomes after esophagectomy alone or nCRT plus surgery for clinically staged node-negative esophageal cancer.
We searched the Surveillance, Epidemiology, and End Results database for patients with clinically node-negative (cN0) esophageal cancer from 2004 to 2016 who underwent surgery alone or nCRT plus surgery. Propensity score matching and Cox regression analysis were used to identify covariates associated with overall survival and cancer-specific survival.
A total of 1587 patients were retrospectively identified, of whom 49.8% (n = 791) received nCRT and 80.2% (n = 1273) were truly node-negative diseases. For the entire cohort, surgery alone was associated with a statistically significant but modest absolute increase in survival outcomes (P < 0.01). After matching, nCRT was associated with improved five-year overall survival for pT3-4N0 (localized) disease (59.6% vs. 37.7%; P < 0.001) and pathological node-positive disease (60.5% vs. 40.7%; P = 0.002). Cox multivariate regression analysis revealed that the addition of nCRT for truly node-negative patients with tumor length ≥ 3 cm, pT1-2N0 (early-staged) and localized disease were independent risk factors for survival than surgery alone (P < 0.01).
Compared with surgery alone, patients with cN0 esophageal cancer with pathological node-positive or localized true node-negative disease gain a significant survival benefit from nCRT. However, nCRT plus surgery was associated with decreased survival for early-staged true node-negative patients. This finding may have significant implications on the use of neoadjuvant chemoradiation in patients with cN0 disease.
新辅助放化疗（nCRT）对早期食管癌的影响尚不清楚。本研究比较了单独行食管癌切除术与 nCRT 联合手术治疗临床分期为淋巴结阴性（cN0）食管癌的疗效。
本研究从 2004 年至 2016 年，在监测、流行病学和最终结果数据库中检索了接受单独手术或 nCRT 联合手术治疗的临床淋巴结阴性（cN0）食管癌患者。采用倾向评分匹配和 Cox 回归分析来确定与总生存和癌症特异性生存相关的协变量。
共回顾性分析了 1587 例患者，其中 49.8%（n=791）接受了 nCRT，80.2%（n=1273）为真正的淋巴结阴性疾病。对于整个队列，单独手术治疗与生存结果的显著但适度的绝对改善相关（P<0.01）。匹配后，nCRT 可改善局部 T3-4N0（局部）疾病（59.6% vs. 37.7%；P<0.001）和病理阳性淋巴结疾病（60.5% vs. 40.7%；P=0.002）患者的五年总生存。Cox 多变量回归分析显示，对于肿瘤长度≥3 cm、pT1-2N0（早期）和局限性疾病的真正淋巴结阴性患者，nCRT 的加入是总生存的独立危险因素，优于单独手术（P<0.01）。
与单独手术相比，病理阳性或局部真正淋巴结阴性的 cN0 食管癌患者接受 nCRT 治疗可显著获益，但 nCRT 联合手术治疗真正淋巴结阴性的早期患者生存率降低。这一发现可能对 cN0 疾病患者应用新辅助放化疗具有重要意义。
