Abstract
BackgroundNeoadjuvant concurrent chemoradiotherapy (nCCRT) is one of the standard-of-care options for locally advanced esophageal squamous cell carcinoma (LA-ESqCC). The optimal interval between nCCRT and esophagectomy is unknown.MethodsWe constructed a propensity-score-matched [1:1 for long (8–12 weeks) vs short (4–7 weeks) intervals] cohort of LA-ESqCC patients who were diagnosed from 2011 to 2015 and treated with nCCRT via the Taiwan Cancer Registry and related databases. We compared the hazard ratios (HRs) of death using a robust variance estimator. We also evaluated alternative covariables, outcomes, and interval definitions.ResultsOur study population included 80 patients for each group; groups were balanced with respect to the observed covariables. There was no significant difference for the HR of death [1.22; 95% confidence interval 0.78–1.91, P = 0.39] when the long interval group was compared to the short interval group. There were also no significant differences when alternative covariables, outcomes, or interval definitions were evaluated.ConclusionsIn this population-based study in modern Asia, we found that for LA-ESqCC patients treated with nCCRT and esophagectomy, overall survival was similar for either long or short intervals between nCCRT and esophagectomy. Randomized controlled trials are needed to verify this finding.
Highlights
Neoadjuvant concurrent chemoradiotherapy is one of the standard-of-care options for locally advanced esophageal squamous cell carcinoma (LA-ESqCC)
Other explanatory covariables We identified patient demographic factors [age, gender, residency region], patient characteristics [drinking, betel nut chewing, smoking, body mass index (BMI)], disease characteristics [tumor size, tumor differentiation, tumor location, clinical T-stage and N-stage], diagnosis method [use of positron emission tomography (PET)], and treatment characteristics [number of lymph nodes removed, radiotherapy (RT) delivery method, RT dose] as potential confounders based on our experiences in clinical practice and modified from our Taiwan Cancer Registry (TCR)/National Health Insurance (NHI) related study [6]
There was no significant difference for hazard ratio (HR) [1.22; 95% confidence interval 0.78–1.91, P = 0.39] when the long interval group was compared to the short interval group
Summary
Neoadjuvant concurrent chemoradiotherapy (nCCRT) is one of the standard-of-care options for locally advanced esophageal squamous cell carcinoma (LA-ESqCC). In contrast to the Western world, where adenocarcinoma is the common histology, the optimal interval between nCCRT and esophagectomy is debated in the literature [7]. (RCT) reported that prolongation was associated with a higher pathological complete response (pCR) [8], a wellknown good prognostic factor [9]. Regarding nCCRT for esophageal cancer, a systematic review of non-RCTs published in 2018 reported that a long interval (> 7–8 weeks, vs ≤ 7–8 weeks) was associated with higher pCR rates but worse overall survival (OS), both with statistical significance [7]. Given the abovementioned geographic variation, controversy in this topic, and lack of RCTs, we aimed to compare the OS of LA-ESqCC treated with nCCRT and esophagectomy in modern Asia with either long or short intervals via a population-based propensity-score-matched analysis
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