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Comparative Study
. 2024 Sep 27;19(1):130.
doi: 10.1186/s13014-024-02528-0.

Propensity-matched study on locally advanced esophageal cancer: surgery versus post-operative radiotherapy

Ya Zeng  1 , Xi Su  1 , Tongfang Zhou  1 , Jingyi Jia  1 , Jun Liu  1 , Wen Yu  1 , Qin Zhang  1 , Xinyun Song  1 , Xiaolong Fu  2 , Xuwei Cai  3
Affiliations
Comparative Study

Propensity-matched study on locally advanced esophageal cancer: surgery versus post-operative radiotherapy

Ya Zeng et al. Radiat Oncol. .

Abstract

Background: This study aims to delineate the long-term outcomes and recurrence patterns of locally advanced thoracic esophageal squamous cell carcinoma (TESCC) patients managed with or without postoperative radiotherapy (PORT).

Methods: A retrospective cohort from two academic centers, encompassing patients who initially underwent esophagectomy and were pathologically staged T3-4, was analyzed. Survival outcomes were constructed using Kaplan-Meier method, with survival significance was evaluated using the log-rank test. Propensity score matching (PSM) was utilized to balance potential selection bias.

Results: Among the 506 patients, 251 underwent surgery alone and 255 received radiotherapy following radical surgery. With a median follow-up of 49.1 months, PORT significantly improved 5-year overall survival (53.8% vs. 25.3%; p < 0.001) and 5-year disease-free survival rates (45.3% vs. 8.5%; p < 0.001) compared to surgery alone. These differences in survival outcomes persisted even after PSM (p < 0.001 for both). Treatment failure was significantly less frequent in the PORT group (46.7%) compared to the surgery-only group (90.0%; p < 0.001), with corresponding reductions in locoregional recurrence (9.4% vs. 54.1%; p < 0.001). This underscores the significant association between PORT and disease control.

Conclusion: The absence of neoadjuvant chemoradiotherapy highlights the importance of PORT in improving survival and reducing recurrence in advanced T3-4 TESCC patients. This study underscores the importance of PORT as a salvage treatment for locally advanced TESCC patients without neoadjuvant chemoradiotherapy.

Keywords: Locally advanced esophageal squamous cell carcinoma; Postoperative radiotherapy; Recurrent pattern; Survival outcomes.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart for patient selection
Fig. 2
Fig. 2
Survival outcomes of the entire population. A Disease-free survival; B overall survival. PORT, postoperative radiotherapy; HR, hazard ratio; CI, confidence Interval; No, number
Fig. 3
Fig. 3
Survival outcomes of patients after propensity-score matching. A Disease-free survival; B overall survival. PORT, postoperative radiotherapy; HR, hazard ratio; CI, confidence Interval; No, number
Fig. 4
Fig. 4
Nomogram models to calculate risk score and predictions of progressive probability and calibration curves. A Local recurrence model; B Total progression model; C calibration curves for (A); D calibration curves for (B). PORT, postoperative radiotherapy
See this image and copyright information in PMC

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