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Analysis of trimodal and bimodal therapy in a selective-surgery paradigm for locally advanced oesophageal squamous cell carcinoma
- Source :
- The British journal of surgery. 108(10)
- Publication Year :
- 2020
-
Abstract
- Background Long-term survival outcomes of trimodal therapy (TMT; chemoradiation plus surgery) and bimodal therapy (BMT; chemoradiation) have seldom been analysed. In a selective-surgery paradigm, the benefit of TMT in patients with a complete clinical response is controversial. Factors associated with survival in patients with a clinical complete response to chemoradiation were evaluated. Methods Patients with stage II–III oesophageal squamous cell carcinoma treated with TMT or BMT from 2002 to 2017 were evaluated. The BMT group consisted of patients who were otherwise eligible for surgery but underwent chemoradiation alone followed by observation. This group included patients who later had salvage oesophagectomy. Survival was evaluated and compared between TMT and BMT groups. Elastic net regularization was performed to select co-variables for Cox multivariable survival analysis in patients with a clinical complete response. Results Of 143 patients, 60 (41.9 per cent) underwent TMT and 83 (58.0 per cent) BMT. Patients who underwent TMT had longer median overall survival than those who had BMT (77 versus 33 months; P = 0.019). For patients with a clinical complete response, TMT achieved longer median overall survival than BMT (123 versus 55 months; P = 0.04). BMT had a high locoregional recurrence rate (48 versus 6 per cent; P Conclusion In patients who achieve a clinical complete response, TMT reduces locoregional recurrence but may not prolong survival. The differences in survival outcomes may be due to patient selection; therefore, a selective-surgery strategy in oesophageal squamous cell carcinoma is a reasonable approach.
- Subjects :
- Male
medicine.medical_specialty
Esophageal Neoplasms
medicine.medical_treatment
Locally advanced
Standardized uptake value
Disease-Free Survival
03 medical and health sciences
0302 clinical medicine
Clinical complete response
Medicine
Humans
Basal cell
030212 general & internal medicine
Stage (cooking)
Neoplasm Metastasis
Survival analysis
Aged
Neoplasm Staging
Proportional Hazards Models
Salvage Therapy
business.industry
Hazard ratio
Chemoradiotherapy, Adjuvant
Middle Aged
Neoadjuvant Therapy
Surgery
Esophagectomy
030220 oncology & carcinogenesis
Female
Esophageal Squamous Cell Carcinoma
Neoplasm Recurrence, Local
business
Subjects
Details
- ISSN :
- 13652168
- Volume :
- 108
- Issue :
- 10
- Database :
- OpenAIRE
- Journal :
- The British journal of surgery
- Accession number :
- edsair.doi.dedup.....eff10d04b07d7dd4ae7cad0882b75cd9