ESCC: neoadjuvant CRT tops esophagectomy in stage 3 disease

  • Hsu PK & al.
  • Ann Surg Oncol
  • 14 Nov 2018

  • curated by Jim Kling
  • Univadis Clinical Summaries
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Takeaway

  • Neoadjuvant chemoradiation therapy (NCRT) is associated with better survival than upfront esophagectomy (UE) in stage 3 esophageal squamous cell carcinoma (ESCC), but both are equally effective in stage 2 disease.

Why this matters

  • The study was used with the 8th edition of the American Joint Committee on Cancer Tumor-Node-Metastasis (TNM) staging system.
  • Previous studies of NCRT vs esophagectomy led to mixed results, but were conducted before the advent of new TNM guidelines.

Study design

  • Retrospective study of the Taiwan Cancer Registry database (n=2503).
  • Funding: None disclosed.

Key results

  • Stage 2:
    • Median survival: 27.8 months with UE, 32.7 months with NCRT.
    • Median 3-year survival rate: 39.2% with UE vs 49.8% with NCRT (P=.508).
    • Power analysis to account for the small sample size, based on a sample size of 300, confirmed no statistically significant effect.
  • Stage 3:
    • After propensity score matching (357 pairs), median survival was 17.9 months with UE vs 24.0 months with NCRT (P<.001>
    • Median 3-year survival rate: 28.2% with UE vs 41.8% with NCRT (P<.001>

Limitations

  • Retrospective design.

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