Definitive chemoradiation therapy or surgery for clinical T1-3N0-1M0 thoracic esophageal squamous cell carcinoma: A propensity score matching analysis

Abstract

Summary: Background: To compare overall survival in patients with clinical T1-3N0-1 thoracic esophageal squamous cell carcinoma treated with surgery or definitive chemoradiation therapy (CRT). Methods: We used propensity-score matching to derive 1:1 cohorts of surgery versus definitive CRT. Statistical analysis was performed using χ2 or Fisher's exact tests. Survival functions were estimated using Kaplan–Meier survival plots, and survival distributions were compared using log-rank tests. Cox proportional hazards modeling was used to analyze the factors affecting overall survival. Results: A total of 334 patients treated with surgery and 252 treated with definitive CRT were included. 129 (38.6%) of 334 patients had recurrence after surgery versus 118 (46.8%) of 252 after definitive CRT. Before matching, the median overall survival were 39.5 months (95% CI, 28.8–50.2) and 23.5 months (95% CI, 18.5–28.5) (P < 0.001) in the surgery and definitive CRT group, respectively. After matching (112 patients in each treatment group), median overall survival was 43.6 months (95% CI, 28.1–59.1) with surgery versus 19.3 months (95% CI, 14.4–24.2) with CRT (P < 0.001). Conclusions: In this retrospective analysis, surgery was associated with better overall survival compared with definitive CRT. Keywords: Esophageal squamous cell carcinoma, Surgery, Chemoradiotherapy