The Impact Of Postoperative Chemoradiotherapy Or Radiotherapy On Survival Of Preoperative Chemotherapy Plus Surgery For Esophageal Squamous Cell Carcinoma

Background and ObjectiveEsophageal cancer is a malignant tumor with high morbidity and mortality.The incidence and mortality of esophageal cancer in China account for more than half of the world.Squamous cell carcinoma accounts for about 90% of esophageal carcinomas in China.The early symptoms of esophageal cancer are not obvious,and a lot of patients are found to have advanced stage.Direct surgery is difficult and the prognosis is poor.Neoadjuvant chemotherapy is widely accepted in the treatment of locally advanced esophageal squamous cell carcinoma,but whether adjuvant chemoradiotherapy or radiotherapy is needed for esophageal squamous cell carcinoma after radical surgery is still unknown.The purpose of this study was to investigate whether adjuvant chemoradiotherapy or radiotherapy can improve the prognosis of patients with locally advanced esophageal squamous cell carcinoma undergoing radical resection after neoadjuvant chemotherapy.Material and MethodsAccording to the inclusion and exclusion criteria,384 patients with locally advanced esophageal squamous cell carcinoma who received preoperative neoadjuvant chemotherapy in Henan Tumor Hospital from January 2014 to December2019 were included.These patients were divided into two groups: one was a group of328 patients undergoing radical resection after neoadjuvant chemotherapy(NCS).Another group of 56 patients received postoperative chemoradiotherapy or radiotherapy after radical resection following neoadjuvant chemotherapy(NCSR).Propensity score matching(PSM)was used to balance inter-group differences between the two groups,maintaining a balance among covariates such as gender,age,degree of differentiation,etc.After matching,each group was included with 53 members.Outcome measures included overall survival(OS)and disease-free survival(DFS).ResultIn the overall study cohort,the 5-year OS rates of NCS group and NCSR group were(60.6% vs.55.8%,P=0.286).Median DFS were(11.7 months,95% confidence interval [CI]: 0.291-0.876;8.9 months,95% CI: 7.054-10.826).The 5-year OS rates of the matched NCS group and NCSR group were(41.3% vs.59.3%,P=0.330),respectively.Median DFS were(12.1 months,95% CI: 4.789-19.331;8.8 months95% CI: 7.719-9.841).ConclusionAdjuvant chemoradiotherapy or radiotherapy did not significantly improve overall survival and disease-free survival of locally advanced esophageal squamous cell carcinoma patients undergoing radical resection after neoadjuvant chemotherapy.Multivariate analysis showed that intravascular invasion,sex,clinical stage and surgical method were independent prognostic factors affecting OS.The vascular intravascular invasion was an independent factor affecting DFS.