Postoperative chemotherapy versus surgery alone in esophageal squamous cell carcinoma: A single-center propensity-matched survival analysis

Background

Current clinical guidelines lack a consensus regarding adjuvant chemotherapy (ACT) for esophageal squamous cell carcinoma (ESCC) patients undergoing primary surgical resection. Therefore, our study evaluates both the survival benefits and predictors in this specific population.

Methods

This retrospective study stratified 1039 ESCC patients into ACT and surgery-only groups. Propensity score matching (PSM) generated 311 matched pairs (n = 622) with balanced baseline characteristics. The endpoints were 5-year DFS and 5-year OS, analyzed by Kaplan-Meier methodology. Prognostic factors were identified through univariable and multivariable Cox regression analyses.

Results

With a median follow-up of 49 months, the post-PSM OS rates at the 1-, 3-, and 5-year were 89.7 %, 66.4 %, and 56.0 %, with DFS rates of 85.8 %, 63.6 %, and 53.9 %, respectively. ACT demonstrated significantly improved 5-year DFS (HR 0.69, 95 % CI 0.53–0.89; P = 0.004) and 5-year OS (HR 0.67, 95 % CI 0.51–0.87; P = 0.003) versus surgery alone. Subgroup analyses demonstrated significant DFS and OS improvements with ACT in patients with pN1-3 disease, pT3-4 tumors, and pT3N0 cases exhibiting either mid/upper thoracic location with moderate/poor differentiation or adverse pathological features (lymphovascular/perineural invasion; all P < 0.05). Multivariable Cox regression identified BMI ≥22 kg/m², ACT, higher lymph node yield, lower metastatic nodal burden, earlier pT/N stages, and absence of LVI/PNI invasion as independent predictors of improved OS and DFS.

Conclusions

ACT demonstrated survival benefits in ESCC patients with advanced tumor burden (pathologically confirmed pT3-4 or pN1-3 disease) and those with pT3N0 cases harboring either mid/upper thoracic tumors with moderate/poor differentiation or adverse pathological features (LVI/PNI).