Neoadjuvant Versus Adjuvant Chemoradiotherapy for Stage II–III Esophageal Squamous Cell Carcinoma: A Propensity Score-Matched Analysis

Abstract

Many clinical trials have explored the value of neoadjuvant or adjuvant chemoradiation therapy in stage II–III squamous cell carcinoma (ESCC). However, these studies have produced conflicting results. This retrospective study was performed to investigate whether patients with stage II/III ESCC should receive neoadjuvant or adjuvant therapy in addition to surgery. A total of 206 patients with clinical stage II and III ESCC who underwent esophagectomy and either neoadjuvant or adjuvant chemoradiation were included. On the basis of the sequence of surgery and chemoradiation, the patients were divided into two groups: Neoadjuvant chemoradiation followed by surgery (neoadjuvant CRT group) and surgery followed by postoperative chemoradiation (adjuvant CRT group). Propensity score matching analysis was used to identify 62 well-balanced patients in each group for outcome comparison. In all, 69 and 137 patients were in the neoadjuvant CRT group and adjuvant CRT group, respectively. Before matching, no differences were observed in the overall survival among the patients in these two groups (P = 0.209). After matching, the survival was similar between neoadjuvant CRT group and adjuvant CRT group (P = 0.933). The median survival times and 1, 3, 5-year overall survival (OS) rates for the neoadjuvant and adjuvant CRT groups were 40.4 versus 41.0 months, 83.3% versus 95.1%, 54.6% versus 54.0%, 37.0% versus 30.7%, respectively. In the subgroup analysis, patients with clinical T3/4 stage and N1 stage tumors were more likely to demonstrate an overall survival benefit from neoadjuvant CRT compared with adjuvant CRT. No survival and perioperative complications difference were observed among esophageal cancer patients in the neoadjuvant CRT and adjuvant CRT groups. However, neoadjuvant CRT is recommended for patients with clinical T3/4 stage and N1 stage tumors.