Affiliation:
1. Department of Thoracic and Cardiovascular Surgery Samsung Medical Center, Sungkyunkwan University School of Medicine Seoul Republic of Korea
2. Patient‐Centered Outcomes Research Institute Samsung Medical Center Seoul Republic of Korea
3. Division of Hematology‐Oncology, Department of Medicine Samsung Medical Center, Sungkyunkwan University School of Medicine Seoul Republic of Korea
Abstract
AbstractBackgroundThe role of adjuvant chemotherapy in esophageal squamous cell carcinoma (ESCC) remains controversial. This study aimed to evaluate the impact of adjuvant chemotherapy on survival in patients with positive nodes after surgery for ESCC.MethodsWe retrospectively reviewed the survival outcomes of node‐positive patients with ESCC who underwent curative resection with or without adjuvant chemotherapy between January 1994 and December 2015.ResultsWe analyzed 460 patients (333 adjuvant chemotherapy, 127 surgery alone). The surgery‐alone group was older (64 vs. 60 years, p < 0.001) and had more comorbidities (p = 0.004) than the adjuvant chemotherapy group. After propensity score matching, overall survival (OS) and recurrence‐free survival (RFS) of the adjuvant chemotherapy group were better than those of the surgery‐alone group: 5‐year OS rate 62.7% (95% confidence interval [CI] 54.4–72.3%) vs. 46.8% (95% CI 38.5–57%, p = 0.001) and 5‐year RFS rate 53.9% (95% CI 45.4–63.9%) vs. 36.2% (95% CI 28.3–46.3%, p < 0.001). Notably, in patients with pT3–4 stage, the adjuvant chemotherapy group had significantly better 5‐year OS rate (41.3% [95% CI 29.3–58.3%] vs. 18% [95% CI 10–32.5%], p = 0.01) and 5‐year RFS rate (37% [95% CI 25.3–53.9%] vs. 12% [95% CI 5.7–25.4%], p < 0.001) than in the surgery‐alone group. In multivariable analysis, adjuvant chemotherapy had a favorable effect on both OS (hazard ratio [HR] 0.562, 95% CI 0.426–0.741, p < 0.001) and RFS (HR 0.702, 95% CI 0.514–0.959; p = 0.026).ConclusionAdjuvant chemotherapy may improve survival in node‐positive patients with ESCC, especially in those with pT3–4 stage.
Subject
Pulmonary and Respiratory Medicine,Oncology,General Medicine