Propensity score analysis of oesophageal cancer treatment with surgery or definitive chemoradiotherapy

Karran, Alex; Blake, Paul A.; Chan, David; Reid, T. D.; Davies, I. L.; Kelly, Catherine; Roberts, S. A.; Crosby, T.; Lewis, Wyn G.

doi:10.1002/bjs.9437

Cited by 31 publications

(32 citation statements)

References 38 publications

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“…6,7 A number of retrospective cohort studies have shown that the rates of survival of patients with esophageal cancer who undergo definitive CRT are similar to those in patients who receive surgical treatment approaches. 8–12 Motoori et al 11 enrolled 173 patients with clinical T1bN0M0 squamous cell carcinoma of thoracic esophagus. In the study, 102 patients were treated with esophagectomy and 71 patients with definitive CRT.…”

Section: Discussionmentioning

confidence: 99%

“…There was no statistically significant overall survival difference between 2 groups. Karran et al 12 retrospectively studied 521 patients with clinical stage I–IVa esophageal cancer (277 in the surgery and 244 in the definitive CRT). They performed propensity score analysis to eliminate the selection bias and found there was no difference in survival after esophageal cancer treatment involving surgery or definitive CRT.…”

Section: Discussionmentioning

confidence: 99%

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Impact of Treatment Modalities on Survival of Patients With Locoregional Esophageal Squamous-Cell Carcinoma in Taiwan

Chen

Hung

et al. 2016

Medicine

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The optimal treatment modality for locoregional esophageal squamous-cell carcinoma (ESCC) is still undetermined. This study investigated the treatment modalities affecting survival of patients with ESCC in Taiwan.Data on 6202 patients who underwent treatment for locoregional esophageal squamous-cell carcinoma during 2008 to 2012 in Taiwan were collected from the Taiwan Cancer Registry. Patients were stratified by clinical stage. The major treatment approaches included definitive chemoradiotherapy, preoperative chemoradiation followed by esophagectomy, esophagectomy followed by adjuvant therapy, and esophagectomy alone. The impact of different treatment modalities on overall survival was analyzed.The majority of patients had stage III disease (n = 4091; 65.96%), followed by stage II (n = 1582, 25.51%) and stage I cancer (n = 529, 8.53%). The 3-year overall survival rates were 60.65% for patients with stage I disease, 36.21% for those with stage II cancer, and 21.39% for patients with stage III carcinoma. Surgery alone was associated with significantly better overall survival than the other treatment modalities for patients with stage I disease (P = 0.029) and was associated with significantly worse overall survival for patients with stage III cancer (P < 0.001). There was no survival risk difference among the different treatment methods for patients with clinical stage II disease.Multimodality treatment is recommended for patients with stage II–III esophageal squamous-cell carcinoma. Patients with clinical stage I disease can be treated with esophagectomy without preoperative therapy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Impact of Treatment Modalities on Survival of Patients With Locoregional Esophageal Squamous-Cell Carcinoma in Taiwan

Chen

Hung

et al. 2016

Medicine

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“…Karran et al 18 reported a study of 727 esophageal cancer patients and used regression adjustment to create a cohort of 521 patients who were available for comparison (277 patients in the surgery group and 244 patients in the CCRT group). The median survival, and 2- and 5-year survival rates after surgery were 27 months, 53.8% and 31.0%, respectively, compared with 28 months, 54.2% and 31.9% after CCRT (p=0.918).…”

Section: Discussionmentioning

confidence: 99%

TNM Staging Matched-pair Comparison of Surgery After Neoadjuvant Chemoradiotherapy, Surgery Alone and Definitive Chemoradiotherapy for Thoracic Esophageal Squamous Cell Carcinoma

et al. 2017

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Introduction: We used the TNM staging matched-pair approach to compare the efficacies of surgery after neoadjuvant chemoradiotherapy (NCT), surgery alone and definitive chemoradiotherapy (CCRT) in patients with localized advanced thoracic esophageal squamous cell carcinoma (ESCC). Methods: A total of 642 patients with ESCC from previous studies were studied. Patients whose treatment involved NCT + surgery and surgery alone were compared with patients receiving CCRT. Prospensity score matched-pair comparison based on pre-treatment TNM staging was developed to assess the efficacies of these treatment options. Results: Prospensity score matched-pair comparison to control for bias generated a cohort of 274 patients who were eligible for comparison. The 3-year OS rate was 70.0% in the NCT + surgery group, compared to 51.7% in the surgery group (p=0.000) and 61.9% in the CCRT group (p=0.082). With the TNM staging matched-pair approach, the CCRT group had more upper thoracic ESCC patients (43/92, 46.7%), while the surgery group had more lower thoracic ESCC patients (37/92, 40.2%). The 3-year OS rates were comparable between the surgery alone group and CCRT group (p=0.109). Conclusions: NCT plus surgery was superior in OS to surgery alone or CCRT. The 3-year OS rates were comparable between the surgery alone group and CCRT group with TNM staging matched-pair approach. Further investigation is warranted to confirm these findings.

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“…However, there are only a few studies comparing the definitive CCRT with surgery alone for esophageal cancer, most of which are prospective Phases I and II clinical trials and retrospective studies, [20][21][22] and only a few of which are randomized clinical trials. 23 Teoh et al 23 reported a randomized trial of 81 patients with operable SCC of the mid-or lower thoracic esophagus with a 5-year OS favoring CRT, although it was not statistically significant (surgery 29.4% and CRT 50%; P=0.147).…”

Section: Surgery Vs Definitive Crt For Esophageal Cancermentioning

confidence: 99%

Esophageal cancer: comparative effectiveness of treatment options

Cai¹,

Lin²

2016

CER

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Esophageal cancer is a lethal disease. Multimodal therapy has improved the survival and local control for locally advanced esophageal cancer compared to surgery alone. Neoadjuvant chemoradiotherapy (CRT) plus surgery is the accepted standard of care for operable esophageal cancer. Pathologic complete response is very common, ranging from 18% to 43%, and it is an independent favorable prognostic factor for survival. Salvage surgery after definitive CRT may be safe and feasible for patients with esophageal cancer who achieve pathologic complete response after neoadjuvant CRT. For inoperable cases, definitive CRT is an alternative treatment modality. Intensity-modulated radiation therapy may reduce treatment-related toxicities due to its better dose homogeneity and conformity compared to three-dimensional conformal radiotherapy. Proton therapy can further improve target conformity and normal tissue sparing when compared to photon therapy (three-dimensional conformal radiotherapy and intensitymodulated radiation therapy) and, therefore, likely to further improve the treatment outcomes of patients. This article compares the effectiveness of the various treatment approaches in the definitive or neoadjuvant setting and reviews the evidence on the benefit of utilizing advanced radiation techniques for the curative management of esophageal cancer.

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Propensity score analysis of oesophageal cancer treatment with surgery or definitive chemoradiotherapy

Abstract: There was no difference in survival after oesophageal cancer treatment involving surgery or dCRT.

Cited by 31 publications

References 38 publications

Impact of Treatment Modalities on Survival of Patients With Locoregional Esophageal Squamous-Cell Carcinoma in Taiwan

Impact of Treatment Modalities on Survival of Patients With Locoregional Esophageal Squamous-Cell Carcinoma in Taiwan

TNM Staging Matched-pair Comparison of Surgery After Neoadjuvant Chemoradiotherapy, Surgery Alone and Definitive Chemoradiotherapy for Thoracic Esophageal Squamous Cell Carcinoma

Esophageal cancer: comparative effectiveness of treatment options

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