| Objective: To explore and compare the curative effect of two therapeutic modalities which based on surgery or radiation respectively for early and locally advanced esophageal squamous cell carcinoma(ESCC). In order to provide some reference for the treatment of ESCC, we make a comparison of which group can benefit more from these two different modalities.Method: We retrospectively reviewed data of 583 pathologically proved ESCC patients administered between January 1st 2007 and Devember 31 st 2013 who ever received curative esophagectomy or definitive radiation. We compare the disease-free survival(DFS), overall survival(OS), and incidence of adverse events according to different therapeutic modalities. Statistical analysis was performed by SPSS19.0. Kaplan-Meier method and Log-rank test were used to calculate the survival rates. The Cox proportional model was used for analyzing prognostic factors.Results:This analysis contains three parts. In the first part of the study, we analyzed the clinical data of 262 cases with thoracic esophageal squamous cancer who received curative esophagectomy. Of these patients, 111 received surgery alone(S group), 91 received adjuvant chemotherapy following surgery(SC group), and 60 underwent adjuvant radiotherapy following surgery(SR group).Median DFS time was 8.9 months, 12.6 months and 16.6 months in S group, SC group and SR group, respectively. Significant difference was observed among three groups over DFS(p=0.026). The DFS rates of SC group and SR group were significantly higher than that of S group(p=0.030;p=0.030), but no significant difference was found between SC group and SR group(p=0.664). Median OS time was 19.6 months in S group, 29.9 months in SC group and 33.0 months in SR group. Similarly, significant difference was observed among three groups over OS(p=0.024).The overall survival rates of SC group and SR group were significantly higher than that of S group(p=0.018;p=0.022), but no significant difference was found between SC group and SR grouptoo(p=0.944). When we analyzed patients with metastasis of regional lymph nodes(p N+), we found that the median DFS time was 5.2 months, 9.5 months and 14.2 months in S group, SC group and SR group respectively. The DFS rates of SC group and SR group were significantly higher than that of S group(p=0.042;p=0.001), but no significant difference was found between SC group and SR group(p=0.180). Median OS time was 15.0 months, 21.4 months and 30.4 months in S group, SC group and SR group respectively. OS of SC group and SR group were significantly higher than that of S group(p=0.035;p=0.001), but no significant difference was found between SC group and SR group too(p=0.310). In patients with p T3-4N+, OS of SC group and SR group were significantly higher than that of S group(p=0.037; p<0.01), and SR group was significantly higher than that of SC group(p=0.011).Median OS time was 15.0 months, 19.9 months and 28.2 months in S group, SC group and SR group, respectively. Multivariate analysis revealed that the depth of tumor invasion(p T) 、numbers of lymph node metastasic(p N)、tumor location and adjuvant therapy were independent prognostic factors.The second part of the research is the survival analysis of 179 ESCC patients who underwent radical radiation. Of these patients, 91 received radiotherapy only(R group), 88 underwent radiotherapycombined with chemotherapy(R+C group). Median DFS time was 7.7 months in R group and 17.1 months in R+C group, respectively. The DFS rate of R+C group was significantly higher than that of R group(p=0.011). Median OS time was 15.8 months, 31.7 months in two groups respectively. OS of R+C group was significantly higher than that of R group(p=0.001). There are 45 patients received concurrent chemoradiation(RC group) and 43 patients received sequential chemoradiation(SRC group). Median DFS time was 7.7 months, 17.1 months and 19.0 months in R group, RC group and SRC group, respectively. The DFS rates of RC group and SRC group were significantly higher than that of R group(p=0.014;p<0.001), but no significant difference was found between RC group and SRC group(p=0.147). Median OS time was15.8 months, 18.8 months and 29.3 months in three groups respectively. OS of RC group and SRC group were significantly higher than that of R group(p=0.038;p=0.002), but no significant difference was found between RC group and SRC group too(p=0.151). There are some patients received induction chemotherapy befor radical radiation, and some received adjuvant chemotherapy following radical radiation. Median DFS time was7.0 months, 12.5 months and 19.6 months in three groups, respectively. Patients who received induction chemotherapy befor radical radiation or adjuvant chemotherapy following radical radiation obtained a better DFS and OS compared with those who received radiotherapy only. But no significant difference was observed both in DFS and OS between induction chemotherapy and adjuvant chemotherapy. Multivariate analysis revealed that the depth of tumor invasion(c T)、lymph node metastasic(c N)、tumor differentiation、clinical stage and chemotherapy in combined with radiotherapy were independent prognostic factors.In the third part of the research, we compared the curative effect of two therapeutic modalities which based on surgery or radiation respectively. Median DFS time was 9.5 months and 16.6 months in surgical therapeutic modality and radiation therapeutic modality, respectively. Median OS time was 18.8 months and 34.6 months in two groups respectively. Patients in surgical group obtained a better OS and DFS compared with radiation group(p=0.011;p<0.001). Median DFS time of S group and R+C group were 13.5 months and 12.4 months, and median OS was 32.0 months and 31.0 months in two groups, respectively. No significant difference was observed between two groups over DFS and OS(p=0.500; p=0.987). According to the tumor location, we found that there is no significant difference was observed between two groups over OS in up- or mid thoracic esophagus. According to tumor stage, we found that median OS were 32.1 months and 46.8 months for patients with stageⅠ-Ⅱin S group and R+C group. Patients in S group obtained a better OS than that of R+C group. But when we analyzed patients with staging Ⅲ, no significant difference between two groups.Conclusion: Adjuvant chemotherapy and adjuvant radiotherapy can improve overall survival of patients with lymph nodes positive as compared with those of surgery alone. Especially for patients with pathology T3-4N0, adjuvant radiotherapy works better. Both chemoradiation and sequential chemoradiation can improve overall survival of patients as compared with radiotherapy alone. Induction chemotherapy followed by radiotion and adjuvant chemotherapy following radical radiotion both can lead to a better survival. For up- or mid-thoracic esophagus, chemoradiation can reach a(an) similar effect on OS as compared with surgery alone. But for lower- thoracic esophagus, surgery works better. Radical CRT for locally advanced ESCC, such as stage Ⅲ, resulted in comparable long-term survival to surgery alone. But for early ESCC, surgery works better. |
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