Comparison of the efficacy of neoadjuvant radiotherapy and adjuvant radiotherapy for patients with T3N0 stage esophageal cancer

Abstract

Objective To compare the efficacy of neoadjuvant radiotherapy and adjuvant radiotherapy in the treatment of patients who underwent radical esophagectomy for T3N0 stage. Methods Totally 555 cases of T3N0, who underwent t neoadjuvant radiotherapy or adjuvant radiotherapy from 2004 to 2014, were selected from the SEER cancer registry in this study. 486 cases received neoadjuvant radiotherapy (neoadjuvant radiotherapy group) and 69 cases received adjuvant radiotherapy (adjuvant radiotherapy group). Kaplan-Meier (KM) survival and multivariate Cox regression analyses were used to analyze the overall survival (OS) and cancer specify survival (CSS) of the two groups. A propensity score model was utilized to balance the baseline covariates. Results The CSS in the neoadjuvant radiotherapy group was significantly better than that in the adjuvant radiotherapy group (χ2=6.030, P<0.05). Multivariate COX regression analysis showed that age, gender, and radiotherapy sequence with surgery were important factors influencing the prognosis of esophageal cancer with T3N0 stage (Wald=10.099, 10.562, 4.331, P<0.05). Compared with the neoadjuvant radiotherapy group, the adjuvant radiotherapy group had a worse CSS (hazard ratio: 1.649, 95%CI 1.173-2.316, P=0.004) and OS (hazard ratio: 1.402, 95%CI 1.020-1.928, P=0.037). According to K-M survival analysis, the adjuvant radiotherapy group showed the worse CSS (hazard ratio: 1.813, 95%CI 1.072-3.069, P=0.027) and OS (hazard ratio: 1.424, 95% CI 0.896-2.262, P=0.134) than the neoadjuvant radiotherapy in esophageal cancer with T3N0 stage, which was similar to the matched cohort. Conclusions Compared with postoperative adjuvant radiotherapy, neoadjuvant radiotherapy significantly improves the CSS and OS of T3N0 patients with esophageal cancer. Key words: Esophageal cancer; Neoadjuvant radiotherapy; Adjuvant radiotherapy