Chemoradiotherapy Before And After Surgery For Locally Advanced Esophageal Squamous Cell Cancer: A Propensity-matched Analysis

BackgroundThe best cooperation between radical surgery and auxiliary and neoadjuvant for operable esophageal cancer is still inconclusive.In foreign countries,there are more preoperative neo-assistances,and more domestic postoperative aids are used.In this study,propensity score matching method was used to compare and analyze the effects of preoperative neoadjuvant chemoradiation and postoperative adjuvant chemoradiation on survival of locally advanced esophageal squamous cell carcinoma and its toxicity analysis to explore the best treatment sequence.methodWe retrospectively analyzed the clinical data of patients with locally advanced esophageal squamous cell carcinoma who were first diagnosed in our hospital from September 2007 to September 2017 and received radical surgery.According to the time before and after radical surgical resection,they were divided into preoperative chemoradiation followed by esophagectomy(Pre-OP CRT)group and postoperative adjuvant chemoradiation(esophagectomy followed postoperative chemoradiation,Post-OP CRT)group.The clinical baseline characteristics between the two groups were compared and analyzed by Pearson chi-square test or independent sample t test.The propensity score matching method is used to create two more balanced comparison groups.The nearest neighbor matching method is adopted,and the caliper value is set to0.03.Kaplan-Meire survival curve method and Log-rank test were used for survival analysis.The main research endpoints are Overall Survival(OS)and Progression-free survival(PFS).ResultThis study enrolled 318 eligible patients with locally advanced esophageal squamous cell carcinoma,including 106 cases in the Pre-OP CRT group and 212 cases in the Post-OP CRT group.The two groups of patients had statistically significant differences in gender,smoking history,weight loss,clinical T staging(c T),clinical N staging(c N),tumor length,and surgical methods,and the p value Both are <0.05.After propensity score matching,there were 53 cases in the Pre-OP CRT group and 53 cases in the Post-OP CRT group.There was no statistically significant difference in the general clinical baseline characteristics and pathological characteristics of the two groups of patients(P>0.05).Comparative analysis results between the two groups: 1)Postoperative pathology: Compared with the Post-OP CRT group,patients receiving neoadjuvant radiotherapy and chemotherapy were observed to have significant pathological relief.The two groups of patients had postoperative pathological T stage,N stage and pulse There were differences in tube violations,and the p values ??were all <0.001.All 53 patients in the Pre-OP CRT group received R0 resection,and the R0 resection rate in the Post-OP CRT group was 96.2%,and the difference was not statistically significant(P=0.495).2)Adverse reactions: postoperative anastomotic leakage(9.4% vs 2.8%),postoperative pneumonia(32.1% vs 30.2%),respiratory failure(1.9% vs 0)in the Pre-OP CRT group and Post-OP CRT group,There was no significant difference in the incidence of abdominal hemorrhage(1.9% vs 0)and myelosuppression(18.9% vs 35.8%)above grade III,with p values >0.05.3)Survival analysis: the whole group of 106 patients with esophageal squamous cell carcinoma The median OS was 46.5 months,and the survival rates for the first,second,and third years were 84.9%,71.7%,and 59.4%,respectively.The median OS of the Pre-OP CRT group and the Post-OP CRT group were 51 months and 43 months,respectively.The 1-year,2-year,and 3-year survival rates of the two groups were 84.9% vs.84.9%,71.7% vs.84.9%,respectively.71.7% and 64.2% vs.54.5%,the difference was not statistically significant(P=0.398).The median PFS of the whole group of patients was 34.5 months,and the PFS at the first,second,and third years were 75.4%,60.2%,and 51.5%,respectively.The median PFS of the Pre-OP CRT group and the Post-OP CRT group were 36 months and 32 months,respectively.The PFS of the two groups were 77.4 vs.73.5% and 62.3% vs.58.1% at 1 year,2 years,and 3 years,respectively.And 52.8% vs.50.2%(P=0.679),the difference was not statistically significant.ConclusionFor operable locally advanced esophageal squamous cell carcinoma,both neoadjuvant chemoradiation and adjuvant chemoradiation can improve survival,but the matching of propensity scores between the two groups has similar effects on the survival rate of operable esophageal cancer.Postoperative complications were also similar in the two groups.It is just that neoadjuvant radiotherapy and chemotherapy have an additional effect of downscaling and increasing R0 resection rate.