Background

This is the first study to compare the long-term outcomes between neoadjuvant chemotherapy + surgery and definitive chemoradiotherapy with proton beam therapy for locally advanced esophageal squamous cell carcinoma.

Methods

We reviewed patients with clinical stage IB–III esophageal squamous cell carcinoma (UICC 7th edition) who underwent neoadjuvant chemotherapy + surgery or definitive chemoradiotherapy with proton beam therapy (2009–2017). Overall survival, progression-free survival, and recurrence or regrowth rates were compared between the two treatment groups. Subgroup analyses of overall survival according to baseline characteristics were also performed.

Results

Forty-three patients received neoadjuvant chemotherapy + surgery (median follow-up 47.4 months) and 60 received definitive chemoradiotherapy with proton beam therapy (median follow-up 51.5 months). Baseline characteristics were similar between the groups except for sex, tumor location, and cT classification. The neoadjuvant chemotherapy + surgery and definitive chemoradiotherapy with proton beam therapy groups had similar 3-year overall survival rates (73.1% and 61.7%, respectively, hazard ratio: 0.88, 95% confidence interval 0.49–1.58, p = 0.66), 3-year progression-free survival rates (46.5% and 45%, respectively, hazard ratio: 1.03, 95% confidence interval 0.62–1.70, p = 0.92), and recurrence or regrowth rates (53.5% vs. 50.0%, p = 0.84). In the subgroup analysis, favorable survival was observed after definitive chemoradiotherapy with proton beam therapy for cT1–2 disease (hazard ratio 2.58, 95% confidence interval 0.84–7.99) and after neoadjuvant chemotherapy + surgery for cT3 or higher disease (hazard ratio 0.32, 95% confidence interval 0.15–0.67, p-for-interaction = 0.002).

Conclusions

Long-term outcomes were comparable between the treatments. The choice of the treatment according to cT classification might affect survival.

中文翻译：

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局部晚期食管鳞癌新辅助化疗后手术与质子束根治性放化疗的回顾性分析

背景

这是第一项比较新辅助化疗 + 手术与根治性放化疗联合质子束治疗局部晚期食管鳞状细胞癌的长期结果的研究。

方法

我们回顾了接受新辅助化疗 + 手术或根治性放化疗与质子束治疗（2009-2017 年）的临床 IB-III 期食管鳞状细胞癌（UICC 第 7 版）患者。比较了两个治疗组的总生存期、无进展生存期和复发率或再生长率。还根据基线特征对总生存期进行了亚组分析。

结果

43 名患者接受了新辅助化疗 + 手术（中位随访 47.4 个月），60 名患者接受了质子束治疗的根治性放化疗（中位随访 51.5 个月）。除了性别、肿瘤位置和 cT 分类外，各组之间的基线特征相似。新辅助化疗 + 手术和根治性放化疗与质子束治疗组的 3 年总生存率相似（分别为 73.1% 和 61.7%，风险比：0.88，95% 置信区间 0.49-1.58，p  = 0.66），3-年无进展生存率（分别为 46.5% 和 45%，风险比：1.03，95% 置信区间 0.62–1.70，p  = 0.92）和复发率或再生长率（53.5% vs. 50.0%，p = 0.84）。在亚组分析中，针对 cT1-2 疾病（风险比 2.58，95% 置信区间 0.84-7.99）和 cT3 或更高疾病的新辅助化疗 + 手术（风险比 0.32， 95% 置信区间 0.15–0.67，p-交互作用 = 0.002）。

结论

治疗之间的长期结果具有可比性。根据 cT 分类选择治疗可能会影响生存。