The role of postoperative adjuvant chemotherapy for lymph node-positive esophageal squamous cell carcinoma: a propensity score matching analysis

Abstract

The prognosis of patients with lymph node-positive esophageal squamous cell carcinoma (ESCC) who primarily receive radical esophagectomy remains poor. In this study, we aimed to retrospectively investigate the role of postoperative adjuvant chemotherapy with docetaxel- or paclitaxel-based regimens in these patients. A total of 434 consecutive patients were included in this study who underwent radical esophagectomy and were pathologically confirmed to have lymph node-positive ESCC from January 2005 to December 2010 in our institution. Among these patients, 113 patients received postoperative adjuvant chemotherapy (Group SC), and 321 patients underwent surgery alone (Group S). Propensity score matching and multivariate analyses were used to compensate for differences in some baseline characteristics. After matching, Group SC had significantly longer median disease-free survival (DFS) than that in Group S (23.63 months vs. 16.70 months; p = 0.006); further subset analysis revealed that a benefit regarding DFS was only associated with patients with N1 stage and with tumor length <4.5 cm. The median overall survival (OS) was similar between the two groups (38.57 months for Group SC vs. 25.27 months for Group S; p = 0.05). Multivariate analysis showed that postoperative chemotherapy, length of the tumor, T status, and N category were significantly independent predictive factors of tumor recurrence (p < 0.05). Our data suggested that adjuvant chemotherapy with docetaxel- or paclitaxel-based regimens could significantly improve DFS for patients with N1 stage and tumor length <4.5 cm ESCC and that it could potentially prolong OS for patients with lymph node-positive ESCC after surgery, compared with surgery alone. These results warrant further confirmation in prospective, randomized trials.

Post-esophagectomy Adjuvant Chemotherapy Benefits Esophageal Cancer Patients

“…These results were consistent with other reports (6,7). Recently, Rong et al have also reported that the group receiving adjuvant chemotherapy with docetaxel-or paclitaxel-based regimens had significantly longer median DFS than the surgery-alone group; however, there was no significant difference in the OS of these groups (8). The effects of preoperative chemotherapy are being evaluated in randomized trials.…”

“…On the other hand, potential disadvantages include the morbidity and mortality associated with toxicity, disease progression with the selection of drug-resistant tumor clones, and the delay of definitive surgical treatment (15). With regard to the survival benefit of postoperative adjuvant chemotherapy, previous reports (5)(6)(7)(8) have shown that adjuvant chemotherapy improves disease-free survival; however, these reports did not result in significant differences in OS as compared with surgery alone. Lyu based adjuvant chemotherapy improved the OS of patients with lymph node-positive thoracic esophageal squamous cell carcinoma as compared with surgery alone (16).…”

Efficacy of postoperative adjuvant chemotherapy for esophageal squamous cell carcinoma: A meta‐analysis

“…In 2016, Qin et al . from China assessed the efficacy of adjuvant chemotherapy in 434 stage II–III ESCC patients with positive lymph nodes confirmed by postoperative pathology and concluded that adjuvant chemotherapy could improve DFS of pN1 ESCC patients and those with tumors < 4.5 cm, as well as OS in patients with positive lymph nodes …”

Current Status and Future Prospects for Esophageal Cancer Treatment

“…43) Lee et al 44) and Zhang et al 45) also reported similar results. Recently, Rong et al 46) also reported that the group given adjuvant chemotherapy with docetaxel-or paclitaxel-based regimens had a significantly longer median DFS than that in the surgery alone group but resulted in no significant difference in OS between these groups. The effects of preoperative chemotherapy are being evaluated in randomized trials.…”