Brian Housman, Shubham Gulati, Ashwin Kulshrestha, Matthew Untalan, Tara Ivic-Pavlicic, Stephanie Tuminello, Karyn A. Goodman, Emanuela Taioli, Raja Flores
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Difference in survival by histology was assessed using Kaplan-Meier curves and Cox Proportional Hazards models.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>A total of 47 170 (78.9%) did not undergo surgery and 12 584 (21.1%) received surgery. The hazard ratio for patients undergoing dCR for SCC was 1.929. The hazard ratio for treatment with dCR compared to chemoradiation-followed-by-surgery (CRS) was 2.151 and for adenocarcinoma 2.386. Further analyses highlight groups under similar clinical conditions; including multivariate analysis, T-Stage, overall stage, surgical era, and surgery refusal. In every category, the risk of mortality was higher in dCR compared to CRS.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>Surgery combined with chemoradiation, and/or surgery alone, confers a significant survival benefit over dCR in resectable patients.</p>\n </section>\n \n <section>\n \n <h3> Discussion</h3>\n \n <p>Surgery should be considered early in medically fit patients with operable disease.</p>\n </section>\n </div>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":"132 5","pages":"977-986"},"PeriodicalIF":1.9000,"publicationDate":"2025-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jso.70085","citationCount":"0","resultStr":"{\"title\":\"Stop Canceling Surgery for Esophageal Cancer: An Analysis of Treatment Related Mortality in 60 000 Patients\",\"authors\":\"Brian Housman, Shubham Gulati, Ashwin Kulshrestha, Matthew Untalan, Tara Ivic-Pavlicic, Stephanie Tuminello, Karyn A. Goodman, Emanuela Taioli, Raja Flores\",\"doi\":\"10.1002/jso.70085\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Background and Methods</h3>\\n \\n <p>Surgical esophagectomy is falsely regarded as contributing little survival in resectable, early-stage disease in favor of nonsurgical treatment with definitive chemoradiation (dCR). We examine surgery in treatment by evaluating large-scale trends in mortality. The SEER database was queried for esophageal cancer patients from 2004 to 2020. Total of 59 754; 19 806 squamous and 34 484 adenocarcinoma. The primary outcome was the hazard ratio for overall survival defined as time from diagnosis-to-death. Differences between patients were assessed using χ<sup>2</sup> tests for categorical variables and <i>t</i>-tests for continuous variables. Difference in survival by histology was assessed using Kaplan-Meier curves and Cox Proportional Hazards models.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>A total of 47 170 (78.9%) did not undergo surgery and 12 584 (21.1%) received surgery. The hazard ratio for patients undergoing dCR for SCC was 1.929. The hazard ratio for treatment with dCR compared to chemoradiation-followed-by-surgery (CRS) was 2.151 and for adenocarcinoma 2.386. Further analyses highlight groups under similar clinical conditions; including multivariate analysis, T-Stage, overall stage, surgical era, and surgery refusal. 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Stop Canceling Surgery for Esophageal Cancer: An Analysis of Treatment Related Mortality in 60 000 Patients
Background and Methods
Surgical esophagectomy is falsely regarded as contributing little survival in resectable, early-stage disease in favor of nonsurgical treatment with definitive chemoradiation (dCR). We examine surgery in treatment by evaluating large-scale trends in mortality. The SEER database was queried for esophageal cancer patients from 2004 to 2020. Total of 59 754; 19 806 squamous and 34 484 adenocarcinoma. The primary outcome was the hazard ratio for overall survival defined as time from diagnosis-to-death. Differences between patients were assessed using χ2 tests for categorical variables and t-tests for continuous variables. Difference in survival by histology was assessed using Kaplan-Meier curves and Cox Proportional Hazards models.
Results
A total of 47 170 (78.9%) did not undergo surgery and 12 584 (21.1%) received surgery. The hazard ratio for patients undergoing dCR for SCC was 1.929. The hazard ratio for treatment with dCR compared to chemoradiation-followed-by-surgery (CRS) was 2.151 and for adenocarcinoma 2.386. Further analyses highlight groups under similar clinical conditions; including multivariate analysis, T-Stage, overall stage, surgical era, and surgery refusal. In every category, the risk of mortality was higher in dCR compared to CRS.
Conclusions
Surgery combined with chemoradiation, and/or surgery alone, confers a significant survival benefit over dCR in resectable patients.
Discussion
Surgery should be considered early in medically fit patients with operable disease.
期刊介绍：
The Journal of Surgical Oncology offers peer-reviewed, original papers in the field of surgical oncology and broadly related surgical sciences, including reports on experimental and laboratory studies. As an international journal, the editors encourage participation from leading surgeons around the world. The JSO is the representative journal for the World Federation of Surgical Oncology Societies. Publishing 16 issues in 2 volumes each year, the journal accepts Research Articles, in-depth Reviews of timely interest, Letters to the Editor, and invited Editorials. Guest Editors from the JSO Editorial Board oversee multiple special Seminars issues each year. These Seminars include multifaceted Reviews on a particular topic or current issue in surgical oncology, which are invited from experts in the field.
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