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A retrospective study of postoperative radiotherapy for locally advanced esophageal squamous cell carcinoma
- Source :
- Annals of Palliative Medicine. 8:708-716
- Publication Year :
- 2019
- Publisher :
- AME Publishing Company, 2019.
-
Abstract
- Background: The optimal therapeutic strategy in locally advanced esophageal squamous cell carcinoma (ESCC) primarily treated by surgery remains unknown. This study was designed to evaluate the impact of postoperative chemoradiotherapy and postoperative sequential chemoradiotherapy on survival in this population. Methods: The study included a total of 228 consecutive patients who underwent radical esophagectomy and were confirmed to have stage pT3–4 or pN+ ESCC from September 2011 to September 2017 at our institution. All patients received postoperative radiotherapy with or without concurrent or sequential chemotherapy after esophagectomy. Univariate and multivariate analyses were used to compare the survival of patients with postoperative radiotherapy, postoperative concurrent chemoradiotherapy, and postoperative sequential chemoradiotherapy. Results: After a median follow-up of 52 months, the 3- and 5-year overall survival (OS) rates were 70.2% [95% confidence interval (CI), 63.7–76.7%] and 62.2% (95% CI, 54.6–69.8%), respectively. The disease-free survival (DFS) rates at 3 and 5 years were 65.2% (95% CI, 58.7–71.7%) and 55.2% (95% CI, 47.6–62.8%), respectively. The 3- and 5-year locoregional recurrence-free survival (LRFS) rates were 65.1% (95% CI, 58.4–71.8%) and 55.5% (95% CI, 47.7–63.3%). Of the 228 patients, 38 (16.7%) had distant metastases. Subgroup analysis showed that being male and having a higher T stage were independent poor prognostic factors for OS and DFS in patients with pN+ or stage III + IVA ESCC. The results also showed that in patients with stage III + IVA ESCC, the DFS of the patients in the concurrent chemotherapy (CCT) group was improved compared with that in the no CCT group [hazard ratio (HR), 0.551; 95% CI, 0.323–0.938; P=0.028]. Multivariate analysis showed that sequential chemoradiotherapy was associated with poor LRFS (HR, 2.312; 95% CI, 1.078–4.959; P=0.031), especially in stage T3–4 patients, and it was also related to the poor DFS (HR, 1.781; 95% CI, 1.086–2.921; P=0.022) in patients with stage T3–4 ESCC. Conclusions: In patients with locally advanced ESCC, those who underwent sequential chemoradiotherapy had a worse LRFS. Postoperative concurrent chemoradiotherapy was the most effective adjuvant therapy for resected stage III–IVA ESCC. In addition, being male, having a higher T stage, and being node-positive were independent poor prognostic factors for OS and DFS.
- Subjects :
- 0301 basic medicine
medicine.medical_specialty
Esophageal Neoplasms
medicine.medical_treatment
Population
Gastroenterology
03 medical and health sciences
0302 clinical medicine
Internal medicine
Adjuvant therapy
Humans
Medicine
Stage (cooking)
education
Retrospective Studies
Advanced and Specialized Nursing
education.field_of_study
Radiotherapy
business.industry
Hazard ratio
Retrospective cohort study
Confidence interval
030104 developmental biology
Anesthesiology and Pain Medicine
Esophagectomy
030220 oncology & carcinogenesis
T-stage
Esophageal Squamous Cell Carcinoma
business
Subjects
Details
- ISSN :
- 22245839 and 22245820
- Volume :
- 8
- Database :
- OpenAIRE
- Journal :
- Annals of Palliative Medicine
- Accession number :
- edsair.doi.dedup.....262898af8d6079ce677162d75dc29787