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Role of Perioperative Chemotherapy in Lymph Node-negative Esophageal Cancer After Resection

A Population-based Study With Propensity Score-matched Analysis

Yang, Yang MD*; Zhou, Xia MD*; Tang, Luoyong MD; Xu, Xiaoling MD; Du, Xianghui MD*; Qiu, Guoqin MD*

American Journal of Clinical Oncology: December 2019 - Volume 42 - Issue 12 - p 924–931
doi: 10.1097/COC.0000000000000624
Original Articles: Thoracic

Background: Multimodality treatment is increasingly accepted and becoming the standard care for local advanced esophageal cancer (EC) patients. However, for early stage lymph node-negative EC patients, surgery alone is still the primary treatment approach, and the role of perioperative chemotherapy remains unclear.

Methods: Patients with lymph node-negative EC were identified from the Surveillance, Epidemiology, and End Results (SEER) database from 2004 to 2013. Survival was compared by the log-rank test. Cox proportional hazards analysis was used to identify covariates associated with overall survival (OS). Propensity score-matched analysis was also performed to control for confounding.

Results: A total of 3071 patients (T1-4N0M0) were identified, 1363 (44.4%) of which received perioperative chemotherapy. The effect of chemotherapy on OS was remarkably dependent on the T stage. For stage T1 patients, chemotherapy was inversely associated with OS (hazard ratio [HR]=1.54; 95% confidence interval [CI], 1.27-1.86), and no impact of chemotherapy on OS was found for T2 patients (HR=0.92; 95% CI, 0.712-1.18), whereas a significant improvement in OS was observed with the addition of chemotherapy for patients with stages T3 (HR=0.52; 95% CI, 0.43-0.62) and T4 (HR=0.60; 95% CI, 0.36-0.98) disease. Multivariable analysis with demonstrated that chemotherapy usage, age, sex, tumor grade, and T stage (P<0.05) were significantly associated with OS in T3-T4 patients. The results were similar in subgroup analyses stratified by confounding covariates, and the propensity score-matched analysis.

Conclusions: This population-based study indicates perioperative chemotherapy is associated with improved survival in stage T3-4N0M0 patients with EC, which needs to be further validated by randomized trials.

*Zhejiang Key Laboratory of Radiation Oncology, Departments of Radiation Therapy

Chemotherapy, Institute of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences, Cancer Hospital of the University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou

Department of Radiation Therapy, Jinhua People’s Hospital, Jinhua, China

Supported by the fund of National Natural Science Foundation of China (No. 81702968) and Zhejiang Province Public Welfare Funds (No. 2017C33092).

The authors declare no conflicts of interest.

Reprints: Guoqin Qiu, MD, Zhejiang Key Laboratory of Radiation Oncology, Department of Radiation Therapy, Zhejiang Cancer Hospital, No. 1, East Banshan Road, Gongshu District, Hangzhou 310022, P.R. China. E-mail:

Online date: October 22, 2019

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