Adjuvant radiotherapy for patients with pathologic node‐negative esophageal carcinoma: A population based propensity matching analysis

Abstract

Background: The impact of adjuvant treatment for esophageal carcinoma with tumor-negative lymph nodes after upfront radical esophagectomy is still uncertain. This study investigated the effects of postoperative radiotherapy in pT1-3N0 esophageal carcinoma after radical resection. Method: We retrospectively identified pT1-3N0M0 esophageal carcinoma patients between 2000 and 2016 from the Surveillance, Epidemiology, and End Results database. Patients with upfront esophagectomy were categorized as having received surgery alone (SA) and surgical resection followed by adjuvant radiotherapy (SA + RT). Propensity score matching, univariate and multivariate analysis were performed to compare overall survival (OS) and cause-specific survival (CSS). Results: A total of 2862 patients were identified, of whom 274 received SA + RT and 2588 received SA. The median follow-up was 60.4 months (95%CI, 58.7-62.1 months). The five-year OS and CSS were better for SA group compared with SA + RT group (P < 0.001, respectively). Furthermore, after matching, the OS and CSS were still significantly better for SA patients. For T subgroup analysis, postoperative radiotherapy was an independent prognostic factor only for pT1 patients with worse OS, without survival differences for pT2 and pT3 patients. However, after multivariate cox analysis, postoperative radiotherapy can provide significantly better OS for pT3 patients with tumor length ≥5 cm (P = 0.03; 95%CI, 0.29-0.94). Conclusions: Among pT1-3N0M0 esophageal carcinoma patients, postoperative radiotherapy can provide significantly better OS for pT3 patients with tumor length ≥5 cm. However, there are no survival benefits for pT1-2 patients after SA + RT procedure. This finding may have significant implications on the use of adjuvant radiation in patients with pN0 disease.

Survival risk prediction model for patients with pT1–3 N0M0 esophageal squamous cell carcinoma after R0 esophagectomy with two-field lymphadenectomy for therapeutic purposes

“…Two studies have already shown that the five-year OS rates were 51.2% for pT 1–3 N 0 M 0 [ 3 ] and 52.9% for stage pN 0 [ 4 ] ESCC patients who underwent two-field surgery without neoadjuvant or adjuvant chemoradiation therapies. Moreover, another study based on 2588 patients with pT 1–3 N 0 M 0 EC [ 18 ] further reported that the postoperative five- and 10-year OS rates were 67.1 and 57.6%, respectively, and the cause-specific survival (CSS) rates were 80.8 and 77.7%, respectively. In this retrospective study, 488 pT 1–3 N 0 M 0 ESCC patients underwent R0 esophagectomy with two-field lymphadenectomy in the absence of either preoperative neoadjuvant or postoperative adjuvant therapy.…”

“…The pT stage was another important independent factor for OS and DFS in our study as well as other studies. The studies by either Xie et al [ 22 ] and Gao et al [ 18 ] reported that the five-year OS rates were 75.1 and 77.8% for pT 1 , 50.4 and 54.2% for pT 2, and 37.0 and 34% for pT 3 ESCC patients with pN 0 after two-field surgery, respectively. Chen et al [ 19 ] reported that the five- and 10-year OS rates were 83.8 and 71.9% for pT 1 N 0 M 0 , 78.8 and 67.4% for pT 2 N 0 M 0 , 67.8 and 51.1% for pT 3 N 0 M 0 ESCC patients after three-field surgery, respectively.…”

“…For the high-risk group, the five-year OS was approximately 50% and postoperative adjuvant therapy should be strongly recommended. Several studies have shown the value of postoperative adjuvant therapy in pN 0 EC patients [ 18 , 19 , 31 , 32 ]; however, the adverse effects related to postoperative adjuvant therapy are a considerable hurdle for patients to undertake therapy. Therefore, it may be more reasonable to select postoperative adjuvant therapy based on the likelihood of postoperative survival and/or recurrence in ESCC patients.…”

Machine-learning algorithm that can improve the diagnostic accuracy of septic arthritis of the knee

“…Since its introduction in 2014, the impact of XGBoost has been widely recognised in several machine learning and data-mining challenges. Recently, it has been widely used for the classification and prediction of medical problems [ 19 , 23 ]. The RF algorithm is a commonly used decision tree-based method with random elements.…”

<p>Postoperative Radiotherapy for Thoracic Esophageal Carcinoma with Upfront R0 Esophagectomy</p>

“…A large number of retrospective studies have suggested that S+RT or S+CRT can improve survival for patients with poor prognostic factors, such as node-positive disease, stage III/IV disease, large tumors, and advanced T stage. 8,9,16,[20][21][22][23][24][25][26][27] A meta-analysis based on four RCTs and eight non-RCTs suggested that PORT was promising in improving 3-year OS and reducing the locoregional recurrence rate. 28 Another meta-analysis based on thirteen published studies confirmed that S+CRT yielded a significant survival benefit and improved local-regional control with tolerable toxicity for EC.…”