Abstract
Purpose
The optimal mode of neoadjuvant treatment for esophageal squamous cell carcinoma (ESCC) has not been well characterized. Our study compared neoadjuvant chemotherapy (NCT) with neoadjuvant chemoradiotherapy (NCRT) for patients with ESCC.
Methods
Data from ESCC patients receiving NCRT or NCT combined with esophagectomy between 2010 and 2018 from the National Cancer Center in China were retrospectively collected. Long-term survival, pathological response, and perioperative mortality and morbidity were compared between the NCRT and NCT groups. A Cox proportional hazards model and propensity score matching (PSM) were used to minimize bias due to potential confounding.
Results
Out of 327 eligible patients with ESCC in our study, 90 patients were identified in each group by PSM. The complete pathologic response (pCR) rate in the NCRT group was markedly higher than that in the NCT group (before PSM: 35.1% vs. 6.0%; after PSM: 38.9% vs. 5.6%; both P < 0.001). The rates of 30-day or 90-day mortality were comparable between the two groups, but the NCRT group had a longer postoperative hospital stay (P < 0.001 before PSM and P = 0.012 after PSM) and more postoperative complications (P < 0.001 before PSM and P = 0.014 after PSM), especially, anastomotic leaks (P = 0.001 before PSM and P = 0.013 after PSM). No significant differences in 5-year overall survival (OS) (P = 0.439) or 5-year relapse-free survival (RFS) (P = 0.611) were noted between unmatched groups, but the trend favored NCRT in the propensity score-matched group (77.3% vs. 61.3%; hazard ratio [HR] 1.57; 95% confidence interval [CI] 0.86–2.87; P = 0.141 for OS, and 77.8% vs. 60.5%; HR 1.72; 95% CI 0.95–3.11; P = 0.073 for RFS). Multivariate analysis showed that only ypT and ypN stages were independent predictors of OS before and after PSM (both P < 0.05).
Conclusion
There was no difference in survival between the NCT and NCRT groups, although a trend favored NCRT related to the significantly higher pCR rates. Prospective head-to-head clinical trials to compare these two types of neoadjuvant therapies in ESCC are warranted.
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Data availability
The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.
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Funding
This work was supported by funds from the National Key Research and Development Program of China [2016YFC1303200].
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JH supervised the project, design, interpretation, manuscript revision, and final approval of the version to be submitted. GCZ, CQZ, NS and QX were involved in concept, data acquisition, analysis and interpretation. GCZ and CQZ wrote the first draft, and revised it critically in light of comments from other authors. GCZ, ZHZ and YJL prepared all the figures and tables. LYX and ZYY reviewed all specimens enrolled in the study. LLF, JWM, YSG and FWT were involved in data acquisition and provided material support. SGG and QX were involved in the manuscript revision and discussion. All authors reviewed and approved the final manuscript.
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The research was approved by the Ethics Committee of Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College (Bei**g, China). Written informed consent was waived because this was a retrospective study.
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Zhang, G., Zhang, C., Sun, N. et al. Neoadjuvant chemoradiotherapy versus neoadjuvant chemotherapy for the treatment of esophageal squamous cell carcinoma: a propensity score-matched study from the National Cancer Center in China. J Cancer Res Clin Oncol 148, 943–954 (2022). https://doi.org/10.1007/s00432-021-03659-7
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DOI: https://doi.org/10.1007/s00432-021-03659-7