216P - Upfront surgery and pathological stage based adjuvant chemoradiation strategy in locally advanced esophageal squamous cell carcinoma

Abstract

Background: Adjuvant chemoradiation is reported to have survival benefit for esophageal squamous cell carcinoma (ESCC). We aim to evaluate the “upfront surgery and pathological stage based adjuvant chemoradiation” strategy, in which adjuvant therapy is guided by pathological stage, in locally advanced ESCC. Methods: Data of 2976 clinical stage II/III ESCC patients, including 1735 in neoadjuvant chemoradiation and 1241 in upfront surgery groups, was obtained from a nationwide database. Pretreatment tumor factors and patient comorbidities were included in the propensity score matching to identify 562 well-balanced pairs for outcome comparison. Patients in upfront surgery group was further categorized into the “upfront surgery and pathological stage based adjuvant chemoradiation” and “upfront surgery only” groups. Results: The 3-year overall survival (OS) rates in “neoadjuvant chemoradiation”, “upfront surgery and pathological stage based adjuvant chemoradiation”, and “upfront surgery only” groups were 41.5%, 45.8%, and 28.5%, respectively. The “upfront surgery and pathological stage based adjuvant chemoradiation” strategy was not a significant prognostic factor (hazard ratio: 1.12; 95% confidence interval: 0.94-1.33, p = 0.195) compared to the “neoadjuvant chemoradiation” group in the multivariable analysis. In propensity score matched patients, the 3-year OS rate was 41.7% in neoadjuvant chemoradiation group, compared to 35.6% in the “upfront surgery and pathological stage based adjuvant chemoradiation” group (p = 0.147), and 20.3% in the “upfront surgery only” group (p < 0.001). Conclusions: No survival difference was observed between the “neoadjuvant chemoradiation followed by surgery” protocol and the “upfront surgery and pathological stage based adjuvant chemoradiation” strategy. Legal entity responsible for the study: Taipei Veterans General Hospital Funding: None Disclosure: The author has declared no conflicts of interest.