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KMID : 0939920220540041148
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대한암학회지
2022 Volume.54 No. 4 p.1148 ~ p.1156
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Role of Esophagectomy after Chemoradiation Therapy in Patients with Locally Advanced Squamous Cell Carcinoma: A Comparative Analysis Stratified by Clinical Response to Chemoradiation Therapy
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Yu Je-Sang
Kim Jong-Hoon
Kim Sung-Bae
Park Sook-Ryun
Kim Young-Hee
Kim Hyeong-Ryul
Lee Hyun-Joo
Song Ho-June
Song Kye-Jin
Jang Jeong-Yun
Jo Yoon-Young
Yoo Ye-Jin
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Abstract
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Purpose: This study aimed to evaluate the long-term effect of esophagectomy in patients with esophageal squamous cell carcinoma (ESCC) by comparing the chemoradiotherapy (CRT)-only group and the trimodality treatment (TMT) group who received concurrent CRT followed by surgery.
Materials and Methods: We included 412 operable ESCC patients treated with TMT or CRT between January 2005 and December 2015. The oncological outcomes of the two groups were compared using a weighted Cox proportional-hazards model with inverse probability of treatment weighting (IPTW).
Results: The median survival time was 64 and 32 months in the TMT (n=270) and CRT (n=142) groups, respectively (p < 0.001). After IPTW, the median overall survival (OS) remained significantly higher in the TMT group than in the CRT group (61 months vs. 32 months, p=0.016). Moreover, the TMT group showed a better local recurrence?free rate (LRFR; p < 0.001) and distant metastasis?free rate (p=0.007). In the subgroup of patients with clinical complete response (cCR), the OS was not significantly different between the two groups, both before and after IPTW adjustment (p=0.35 and p=0.93). However, among non-cCR patients, the OS was significantly higher in the TMT group (64% vs. 45%, p < 0.001).
Conclusion: In patients with locally advanced ESCC, TMT was superior to CRT in terms of OS and LRFR. Such difference was more prominent in the non-cCR subgroup. In patients who achieved cCR, esophagectomy was effective in improving LRFR but not OS, suggesting that esophagectomy may be omitted in complete responders.
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KEYWORD
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Esophageal neoplasms, Squamous cell carcinoma, Chemoradiotherapy, Trimodality treatment, Clinical complete response
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