Value and application of trimodality therapy or definitive concurrent chemoradiotherapy in thoracic esophageal squamous cell carcinoma
Journal
Cancer
Journal Volume
123
Journal Issue
20
Pages
3904-3915
Date Issued
2017
Author(s)
Abstract
BACKGROUND: Few large, prospective, randomized studies have investigated the value and optimal application of neoadjuvant chemoradiotherapy followed by surgery (trimodality therapy) or definitive concurrent chemoradiotherapy (CCRT) for patients with thoracic esophageal squamous cell carcinoma (TESCC). METHODS: The authors analyzed data from patients with TESCC in the Taiwan Cancer Registry database. To compare their outcomes, patients with TESCC were enrolled and categorized into the following groups according to treatment modality: group 1, those who underwent surgery alone; group 2, those who received trimodality therapy; and group 3, those who received definitive CCRT. Group 1 was used as the control arm for investigating the risk of mortality after treatment. RESULTS: In total, 3522 patients who had TESCC without distant metastasis were enrolled. Multivariate Cox regression analysis indicated that a Charlson comorbidity index score ?3, American Joint Committee on Cancer stage ?IIA, earlier year of diagnosis, alcohol consumption, cigarette smoking, and definitive CCRT were significant, independent predictors of a poor prognosis. After adjustment for confounders, adjusted hazard ratios and 95% confidence intervals (CIs) for overall mortality in patients with clinical stage I, IIA, IIB, IIIA, IIIB, and IIIC TESCC were 2.01 (95% CI, 0.44-6.18), 1.65 (95% CI, 0.99-2.70), 1.48 (95% CI, 0.91-2.42), 0.66 (95% CI, 1.08-1.14), 0.39 (95% CI, 0.26-0.57), and 0.44 (95% CI, 0.24-0.83), respectively, in group 2; and 2.06 (95% CI, 1.18-3.59), 2.65 (95% CI, 1.76-4.00), 2.25 (95% CI, 1.49-3.39), 1.34 (95% CI, 0.79-2.28), 0.82 (95% CI, 0.57-1.17), and 0.93 (95% CI, 0.51-1.71), respectively, in group 3. CONCLUSIONS: Trimodality therapy may be beneficial for the survival of patients with advanced-stage (IIIA-IIIC) TESCC, and CCRT might be an alternative to surgery alone in these patients. Cancer 2017;123:3904-15. ? 2017 American Cancer Society. ? 2017 American Cancer Society
Subjects
concurrent chemoradiotherapy (CCRT); squamous cell carcinoma; surgery alone; thoracic esophageal cancer; trimodality therapy
SDGs
Other Subjects
adult; aged; alcohol consumption; Article; cancer diagnosis; cancer mortality; cancer prognosis; cancer registry; cancer staging; cancer surgery; Charlson Comorbidity Index; chemoradiotherapy; cohort analysis; concurrent chemoradiotherapy; controlled study; esophageal squamous cell carcinoma; female; human; major clinical study; male; middle aged; mortality risk; overall survival; priority journal; smoking; survival rate; Taiwan; thoracic esophageal squamous cell carcinoma; abdominal surgery; Carcinoma, Squamous Cell; chemoradiotherapy; drinking behavior; epidemiology; Esophageal Neoplasms; esophagus; factual database; Kaplan Meier method; mortality; multimodality cancer therapy; multivariate analysis; neoadjuvant therapy; pathology; prognosis; proportional hazards model; register; surgery; very elderly; young adult; Adult; Aged; Aged, 80 and over; Alcohol Drinking; Carcinoma, Squamous Cell; Chemoradiotherapy; Combined Modality Therapy; Databases, Factual; Digestive System Surgical Procedures; Esophageal Neoplasms; Esophagus; Female; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Multivariate Analysis; Neoadjuvant Therapy; Neoplasm Staging; Prognosis; Proportional Hazards Models; Registries; Smoking; Taiwan; Young Adult
Type
journal article