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. 2024 Oct 31;16(10):6651-6663.
doi: 10.21037/jtd-24-806. Epub 2024 Oct 29.

A propensity score-matched analysis to evaluate the benefit of adjuvant therapy on disease recurrence of esophageal squamous cell carcinoma after R0 esophagectomy

Yuqin Cao #  1 , Qingqing Hu #  2 , Yajie Zhang  1 , Chengqiang Li  1 , Yuan Zhou  3 , Yongjing Zhang  2 , Hong Qiu  4 , Hecheng Li  1
Affiliations

A propensity score-matched analysis to evaluate the benefit of adjuvant therapy on disease recurrence of esophageal squamous cell carcinoma after R0 esophagectomy

Yuqin Cao et al. J Thorac Dis. .

Abstract

Background: Esophageal squamous cell carcinoma (ESCC) is common in China and has a poor prognosis despite radical surgery. Guidelines around the use of adjuvant therapy (AT) in ESCC are indecisive. We assessed the benefit of AT on recurrence-free survival (RFS) in Chinese patients with ESCC using propensity score (PS) matching.

Methods: This retrospective cohort study used hospital electronic medical records (EMRs) of 523 adults diagnosed between 2013 to 2019 with pathologically confirmed ESCC after R0 esophagectomy without neoadjuvant therapy. PSs were calculated using a generalized linear regression model based on demographic, clinical, and pathologic features. Patients with and without AT were matched using nearest neighbor method and caliper value 0.05. Subgroup analyses were stratified by PS.

Results: Younger patients with more advanced/poorly differentiated disease were more likely to receive AT (P<0.05). There were 137 matched pairs in the AT/No AT groups. After matching, the AT group tended to have longer median RFS [95% confidence interval (CI): 2.21 years (1.54-3.20)] than the No AT group [1.75 years (1.37-2.21)] (P=0.18). The benefit was significant in patients with PS ≥0.40 [hazard ratio 0.55, 95% CI: 0.32-0.87, median RFS (95% CI): 2.22 years (1.30-3.52) versus 1.23 years (0.90-1.64), P=0.03]. In other PS subgroups, median RFS was similar in AT and No AT groups.

Conclusions: After adjusting for baseline characteristics, AT tended to improve RFS after R0 esophagectomy in Chinese patients, with significant benefit associated with a higher PS score. The utility of PS to guide patient selection for AT in clinical practice needs further investigation.

Keywords: Esophageal cancer; propensity score matching (PS matching); recurrence-free survival (RFS); squamous cell carcinoma; survival.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-24-806/coif). Q.H., Yuan Zhou, Yongjing Zhang, and H.Q. are employees of Johnson & Johnson. H.Q. and Yongjing Zhang hold stock/shares in Johnson & Johnson. H.L. reports funding from the National Natural Science Foundation of China (No. 82072557), National Key Research and Development Program of China (No. 2021YFC2500900), Shanghai Municipal Education Commission - Gaofeng Clinical Medicine Grant (No. 20172005, the 2nd round of disbursement), Program of Shanghai Academic Research Leader from Science and Technology Commission of Shanghai Municipality (No. 20XD1402300), Novel Interdisciplinary Research Project from Shanghai Municipal Health Commission (No. 2022JC023), and Interdisciplinary Program of Shanghai Jiao Tong University (No. YG2023ZD04). Yajie Zhang reports funding from the Clinical Research Project in Health Services of Shanghai Municipal Health Commission (No. 202240089). The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Patient selection. SCC, squamous cell carcinoma; AT, adjuvant therapy.
Figure 2
Figure 2
Kaplan-Meier curves (log-rank tests) for recurrence-free survival in patients who did/did not receive adjuvant therapy. (A) Before matching. (B) After matching.
Figure 3
Figure 3
Kaplan-Meier curves (log-rank tests) for recurrence-free survival in patients who did/did not receive adjuvant therapy by PS stratum. (A) PS <0.20. (B) 0.20≤ PS <0.30. (C) 0.30≤ PS <0.40. (D) PS ≥0.40. PS, propensity score.
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