Causes of death in locally advanced esophageal cancer undergoing neoadjuvant chemotherapy and neoadjuvant chemoradiotherapy: a retrospective cohort study.

Purpose: To compare the causes of death in patients with locally advanced esophageal cancer treated with neoadjuvant chemotherapy versus neoadjuvant chemoradiotherapy followed by surgery.

Materials and methods: A retrospective cohort study was conducted on patients with stage T3-4aN0M0/T1-4aN1-3 M0 esophageal cancer who underwent either neoadjuvant chemotherapy or neoadjuvant chemoradiotherapy followed by surgery. Overall survival (OS) and specific causes of death were analyzed and compared between the two treatment groups.

Results: A total of 4528 patients were included: 333 (7.4%) received neoadjuvant chemotherapy, and 4195 (92.6%) underwent neoadjuvant chemoradiotherapy. The 5-year OS was comparable between the two groups, both before (42.4% vs. 39.7%; hazard ratio [HR] = 1.14, 95% confidence interval [CI]: 0.98-1.33; P = 0.097) and after (42.2% vs. 42.2%; HR = 1.07, 95% CI: 0.86-1.31; P = 0.567) propensity score matching. The cumulative 5-year absolute risk of death from esophageal cancer (49.9% vs. 50.6%, P = 0.470), death from non-tumor causes (7.8% vs. 9.7%, P = 0.160), death due to lung causes (2.8% vs. 1.4%, P = 0.432), and death from heart-related causes (2.2% vs. 2.0%, P = 0.524) were similar between the two treatment groups.

Conclusion: In patients with locally advanced esophageal cancer, OS and the causes of death were comparable between those receiving neoadjuvant chemotherapy and those undergoing neoadjuvant chemoradiotherapy.