Comparison of safety and efficacy between chemoradiotherapy and chemotherapy after R0 resection in pN + esophageal squamous cell carcinoma patients

Lingling XIA; Yongshun CHEN; Bin LI; Tingting NING; Caiyutian ZHANG

ABSTRACT

Objective:

To investigate the safety and efficacy of chemoradiotherapy compared with chemotherapy after R0 excision in pN + esophageal squamous cell carcinoma (ESCC) patients.

Methods:

A retrospective analysis was performed on the pathological data of 99 pN + ESCC patients who underwent radical esophagectomy with R0 resection in Renmin Hospital of Wuhan University from January 2017 to December 2020. According to postoperative adjuvant treatment methods, the patients were divided into chemo-radiotherapy group ( n=41) and chemotherapy group ( n=58). The main outcome measures were disease-free survival (DFS), overall survival (OS) and the incidences of treatment-related adverse events. Kaplan-Meier method was used to draw the survival curve accompanied with log-rank test. Cox regression model was used to analyze the prognostic factors.

Results:

The median DFS and OS of 99 patients were 20.0 months and 28.0 months respectively. The 1- and 3-year DFS rates were 60.8% and 34.5% respectively. The 1- and 3-year OS rates were 83.5% and 40.2% respectively. The median DFS was 39.0 months in the chemoradiotherapy group and 10.0 months in the chemotherapy group, and the 1- and 3-year DFS rates were 79.4% vs. 48.3% and 57.3% vs. 24.5% respectively, with a statistically significant difference ( χ2=12.27, P<0.001). The median OS in the chemoradiotherapy group was not reached, and 21.0 months in the chemotherapy group, and the 1- and 3-year OS rates of the chemoradiotherapy group and chemotherapy group were 92.1% vs. 75.9% and 60.8% vs. 27.3%, with a statistically significant difference ( χ2=11.12, P=0.001). Univariate analysis showed that pN stage ( HR=0.58, 95% CI 0.34-0.97, P=0.038), nerve invasion ( HR=1.88, 95% CI 1.11-3.20, P=0.020) and adjuvant therapy ( HR=0.37, 95% CI 0.21-0.67, P<0.001) were independent influencing factors of DFS in pN + ESCC patients. Adjuvant therapy ( HR=0.33, 95% CI 0.17-0.66, P=0.001) was an independent factor influencing OS in pN + ESCC patients. Multivariate analysis showed that pN stage ( HR=0.54, 95% CI 0.30-0.97, P=0.038) and adjuvant therapy ( HR=0.38, 95% CI 0.21-0.69, P=0.001) were independent prognostic factors of DFS. Adjuvant therapy ( HR=0.34, 95% CI 0.17-0.69, P=0.003) was an independent prognostic factor for OS. During adjuvant therapy, there were statistically significant differences in the incidences of leukopenia [65.85% (27/41) vs. 31.03% (18/58), χ2=11.75, P=0.001], thrombocytopenia [29.27% (12/41) vs. 10.34% (6/58), χ2=5.78, P=0.016], radioactive esophagitis [21.95% (9/41) vs. 0 (0/58), χ2=11.48, P=0.001], and radioactive pneumonia [21.95% (9/41) vs. 0 (0/58), χ2=11.48, P=0.001] between the two groups.

Conclusion:

Compared with chemotherapy, chemoradiotherapy can significantly improve DFS and OS of pN + ESCC patients with R0 resection after radical surgery, and the adverse reactions can be tolerated. pN stage and adjuvant therapy are independent prognostic factors for DFS, and adjuvant therapy is an independent prognostic factor for OS.