Study On The Recurrence Mode Of Neoadjuvant Chemoradiotherapy And Postoperative Adjuvant Chemoradiotherapy In Thoracic Esophageal Squamous Cell Carcinoma

Objective:For patients with locally advanced esophageal cancer,the optimal sequence of surgery combined with chemoradiotherapy is unclear,This study was to compare the neoadjuvant chemoradiotherapy(NCRT)and postoperative adjuvant chemoradiotherapy(ACRT)in patients with esophageal cancer recurrence pattern and survival outcome,The clinical factors affecting the prognosis of patients with recurrence were analyzed.Method: A retrospective analysis was performed on 262 patients with locally advanced esophageal squamous cell carcinoma who received treatment in Sichuan Cancer Hospital from January 2018 to December 2020.According to different treatment regiments,they were divided into neoadjuvant chemoradiotherapy group(177 cases)and postoperative adjuvant chemoradiotherapy group(85 cases).By using the propensity score matching(PSM)method,both groups were 76 cases after PSM.Recurrence type,site,frequency,time,overall survival,relapse-free survival and prognostic risk factors were compared between the two groups.Results: The recurrence rate of preoperative neoadjuvant chemoradiotherapy group was 31.6%(24/76),and that of postoperative adjuvant chemoradiotherapy group was 34.2%(26/76),without statistical difference(P=0.863).Recurrence occurred mainly within 2years after resection of esophageal cancer.The mediastinal lymph node recurrence rate in the neoadjuvant chemoradiotherapy group was significantly higher than that in the postoperative adjuvant chemoradiotherapy group(50% vs.19.2%;p=0.022).The median follow-up time was 41.2 months.The 3-year overall survival rate(OS)of neoadjuvant chemoradiotherapy group was 75.83%.The OS of postoperative adjuvant chemoradiotherapy group was 68.79%,with no statistical difference(P=0.601).There were differences in 3-year overall survival among patients with different recurrence types:early recurrence vs late recurrence(2.9% vs 45.29%;P<0.001),recurrent vs non-recurrent(29.28% vs 95.09%;P<0.001),local recurrence vs distant metastasis(30.11% vs 28.8%;P=0.616).In the subgroup with positive lymph nodes after surgery,the relapse-free survival(RFS)in the adjuvant chemoradiotherapy group was better than that in the neoadjuvant chemoradiotherapy group(P=0.019).The results of multivariate analysis showed that pathological N stage was an independent risk factor affecting the overall survival prognosis of patients in the neoadjuvant chemoradiotherapy group.Resection margin and pathological T stage were independent risk factors affecting the overall survival of patients in the postoperative adjuvant chemoradiotherapy group,while gender and treatment plan were independent risk factors affecting the relapse-free survival of patients with postoperative pathological lymph node positive.Conclusion: There was no difference between neoadjuvant chemoradiotherapy and postoperative adjuvant chemoradiotherapy in overall survival and recurrence free survival of patients with esophageal cancer.Recurrence occurred mainly within 2 years after resection of esophageal cancer.The mediastinal lymph node recurrence rate of neoadjuvant chemoradiotherapy was higher than that of postoperative adjuvant chemoradiotherapy.The survival prognosis of patients with early recurrence is worse than that of patients with late recurrence.There was no difference in survival between local recurrence and distant metastasis.Pathological N stage is an independent risk factor affecting the overall survival prognosis of patients in the neoadjuvant chemoradiotherapy group.Resection margin and pathological T stage were independent risk factors affecting the overall survival of patients in the postoperative adjuvant chemoradiotherapy group,while gender and treatment plan were independent risk factors affecting the relapse-free survival of patients with postoperative pathological lymph node positive.