The Role of Adjuvant Chemotherapy in the Treatment of Esophageal Squamous Cell Carcinoma after Neoadjuvant Chemotherapy.

Abstract

Background: The aim of this study was to compare the efficacy of adjuvant chemotherapy after neoadjuvant chemotherapy in patients with esophageal squamous cell carcinoma (ESCC). Methods: This retrospective study included patients diagnosed with ESCC at clinical stage T1N1-3M0 or T2-4N0-3M0. Six hundred and eleven patients underwent radical tumor surgical resection after neoadjuvant chemotherapy. Adjuvant chemotherapy was mainly a platinum-based combination regimen. Propensity score matching (PSM) was used to compare adjuvant chemotherapy (AC) vs. postoperative observation (POB) after surgery. Results: A total of 611 patients were eligible, with 381 in the POB group and 230 in the AC group. POB group patients were younger (P=0.046) and at a later stage (ypT3/4: 127 [55%] vs. 177 [46%]), P=0.036; yPN+: 117[51%] vs. 3428[37%], P=0.001) before PSM. After 1:1 PSM, 213 pairs of patients were included in analysis. The 5-year overall survival (OS) was 60.6% and 57.2% in the POB and AC groups, respectively (HR 1.10, 95% CI: 0.80-1.51, P=0.562), and adjuvant chemotherapy did not improve OS compared with postoperative observation. Conclusions: Postoperative adjuvant chemotherapy cannot improve the OS of patients with ESCC after neoadjuvant chemotherapy, but adjuvant chemotherapy tends to benefit ypN+ patients.