Adjuvant Therapeutic Modalities Following Three-field Lymph Node Dissection for Stage II/III Esophageal Squamous Cell Carcinoma

Abstract

Background: The rates of locoregional and distant recurrence for esophageal squamous cell carcinoma (ESCC) patients underwent radical esophagectomy remain high. The purpose of this study is to explore an optimal postoperative therapeutic modality by investigating the efficacy of various adjuvant therapies in the treatment of ESCC. Methods: We retrospectively reviewed 408 ESCC patients underwent thoracic esophagectomy and 3-field lymph node dissection from 2010 to 2015. Patients were classified into surgery alone (Group S), adjuvant chemotherapy (Group CT) and postoperative chemotherapy plus radiotherapy (Group CRT), respectively. Univariate and multivariate Cox regression analyses were used to analyze prognostic factors and survival. Results: The overall survival (OS) and disease-free survival (DFS) were similar among groups. Postoperative CT and CRT both were beneficial for patients with positive lymph nodes, particularly for those with 3 or more lymph nodes involvement and metastasis in the middle thoracic segment compared with surgery alone. The 3-year OS and DFS for patients with 3 or more lymph nodes involvement were 30.8%, 53.7%, 50.5% and 19.9%, 41.6%, 34.0% for Group S, CT, and CRT, respectively (p=0.04; p=0.004, respectively). There was no notable difference in OS and DFS between the adjuvant Group CT and CRT (p=0.42; p=0.49, respectively). Postoperative CRT significantly reduced the rates of distant metastasis and overall recurrence for patients with positive lymph nodes (p=0.042; p=0.01, respectively). Number of metastatic lymph nodes, extent of resection, and AJCC stage were independent predictors of survival. Grade 1-2 myelosuppression was experienced significantly more frequently by patients in Group CRT than those in Group CT (P=0.03). Late toxicities were rare and manageable overall. Conclusions: Postoperative CT and CRT both were associated with better survival for patients with positive lymph nodes, particularly for those with 3 or more lymph nodes involvement and metastasis in the middle thoracic segment. Postoperative CRT was significantly more effective at reducing the rates of distant metastasis and overall recurrence for patients with positive lymph nodes.

The impact of adjuvant therapies on patient survival and the recurrence patterns for resected stage IIa–IVa lower thoracic oesophageal squamous cell carcinoma

“…Chemotherapy not only can control systematic cancer metastasis but can also exhibit a radio-sensitising effect when concurrent chemoradiotherapy is used. Many studies have concluded that aCRT can improve survival for advanced ESCC [ 12 , 13 , 15 ]. There were only a few studies that evaluated the efficiency of adjuvant chemotherapy, and most of these studies showed that aCRT might improve survival only for patients with PPLNs [ 26 ].…”

Radical esophagectomy for stage II and III thoracic esophageal squamous cell carcinoma followed by adjuvant radiotherapy with or without chemotherapy: Which is more beneficial?

“…There is no high‐quality evidence to evaluate the effect of post‐operative treatment approaches and adjuvant treatments are the optimal choices with the purpose of reducing local recurrence and distant metastasis for radical ESCC patients in China. Moreover, it is still controversial whether adjuvant therapy should be applied after radical surgery because the conclusions of existing research on adjuvant therapy of ESCC are inconsistent . As an important regional treatment, radiotherapy can eliminate the residual tumor cells around the tumor beds and local lymphatic drainage areas, thereby reducing the local recurrence rate .…”

“…Moreover, it is still controversial whether adjuvant therapy should be applied after radical surgery because the conclusions of existing research on adjuvant therapy of ESCC are inconsistent. [1][2][3][4][5][6][7] As an important regional treatment, radiotherapy can eliminate the residual tumor cells around the tumor beds and local lymphatic drainage areas, thereby reducing the local recurrence rate. 8 However, subclinical metastases outside the radiotherapy area may be a source of future recurrence and metastasis.…”

DNA methylation data‐based prognosis‐subtype distinctions in patients with esophageal carcinoma by bioinformatic studies

“…Nevertheless, the limitation of the TNM system in clinical practice might give rise to inaccurate prognostic estimation. Increasing attention has been currently paid to patients with Stage III and IV ESCA, in whom, adjuvant chemotherapy could enhance prognostic outcomes (L. Li et al, 2017;B. Y. Wang et al, 2014;L.…”