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Comparative Study
. 2024 Nov 21;14(1):28898.
doi: 10.1038/s41598-024-80653-2.

Surgery alone versus neoadjuvant chemoradiotherapy followed by surgery in patients with stage T2N0M0 esophageal cancer

Yan Lin  1 , Shou-Feng Wang  2 , Huan-Wei Liang  3 , Yang Liu  3 , Wei Huang  3 , Xin-Bin Pan  4
Affiliations
Comparative Study

Surgery alone versus neoadjuvant chemoradiotherapy followed by surgery in patients with stage T2N0M0 esophageal cancer

Yan Lin et al. Sci Rep. .

Abstract

To compare the survival outcomes of patients with stage T2N0M0 esophageal cancer treated with surgery alone versus those treated with neoadjuvant chemoradiotherapy followed by surgery. Patients with stage T2N0M0 esophageal cancer, who either underwent surgery alone or received neoadjuvant chemoradiotherapy followed by surgery, were extracted from the Surveillance, Epidemiology, and End Results database covering the period from 2000 to 2020. Cancer-specific survival (CSS) and overall survival (OS) between the two treatment groups were compared. A total of 583 patients were included: 267 (45.8%) received surgery alone, while 316 (54.2%) underwent neoadjuvant chemoradiotherapy followed by surgery. Prior to propensity score matching, no significant differences were observed between the surgery alone and neoadjuvant chemoradiotherapy groups in terms of 5-year CSS (60.86% vs. 59.02%; hazard ratio [HR] = 1.01, 95% confidence interval [CI]: 0.79-1.29; P = 0.916) and OS (50.64% vs. 49.81%; HR = 0.91, 95% CI: 0.75-1.12; P = 0.375). After propensity score matching, the 5-year CSS (66.43% vs. 56.67%; HR = 1.21, 95% CI: 0.89-1.64; P = 0.225) and OS (56.49% vs. 47.37%; HR = 1.09, 95% CI: 0.85-1.40; P = 0.481) remained statistically similar between the two groups. Subgroup analyses of patients with squamous cell carcinoma and adenocarcinoma revealed no significant differences in survival outcomes between the treatment modalities for either histological subtype. Neoadjuvant chemoradiotherapy followed by surgery does not confer a survival advantage over surgery alone in patients with stage T2N0M0 esophageal cancer, irrespective of histological subtype.

Keywords: Chemoradiotherapy; Esophageal cancer; Stage T2N0M0; Surgery; Survival outcomes.

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Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests. Ethics approval and consent to participate: Ethics approval was waived by the ethics committee/Institutional Review Board of Guangxi Medical University Cancer Hospital. Informed consent: Informed consent was waived by the ethics committee/Institutional Review Board of Guangxi Medical University Cancer Hospital.

Figures

Fig. 1
Fig. 1
Logistic regression analysis for factors associated with neoadjuvant chemoradiotherapy followed by surgery in patients with stage T2N0M0 esophageal cancer. The analysis identifies significant predictors for choosing chemoradiotherapy + surgery over surgery.
Fig. 2
Fig. 2
Survival outcomes of patients with stage T2N0M0 in the unmatched cohort. (A) Cancer-specific survival between surgery alone and neoadjuvant chemoradiotherapy followed by surgery groups. (B) Multivariable proportional hazards regression analysis of cancer-specific survival. (C) Overall survival between surgery alone and neoadjuvant chemoradiotherapy followed by surgery groups. (D) Multivariable proportional hazards regression analysis of overall survival.
Fig. 3
Fig. 3
Survival outcomes of patients with stage T2N0M0 in the matched cohort. (A) Cancer-specific survival between surgery alone and neoadjuvant chemoradiotherapy followed by surgery groups. (B) Multivariable proportional hazards regression analysis of cancer-specific survival. (C) Overall survival between surgery alone and neoadjuvant chemoradiotherapy followed by surgery groups. (D) Multivariable proportional hazards regression analysis of overall survival.
Fig. 4
Fig. 4
Survival outcomes of patients with esophageal squamous cell carcinoma. (A) Comparison of cancer-specific survival between surgery alone and neoadjuvant chemoradiotherapy followed by surgery groups. (B) Multivariable proportional hazards regression analysis of cancer-specific survival. (C) Comparison of overall survival between surgery alone and neoadjuvant chemoradiotherapy followed by surgery groups. (D) Multivariable proportional hazards regression analysis of overall survival.
Fig. 5
Fig. 5
Survival outcomes of patients with adenocarcinoma. (A) Comparison of cancer-specific survival between surgery alone and neoadjuvant chemoradiotherapy followed by surgery groups. (B) Multivariable proportional hazards regression analysis of cancer-specific survival. (C) Comparison of overall survival between surgery alone and neoadjuvant chemoradiotherapy followed by surgery groups. (D) Multivariable proportional hazards regression analysis of overall survival.
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