Trimodal Therapy in Esophageal Squamous Cell Carcinoma: Role of Adjuvant Therapy Following Neoadjuvant Chemoradiation and Surgery

Li, Xiao-Kun; Luan, Siyuan; Yang, Yu‐Shang; Zhou, Jianfeng; Shang, Qi‐Xin; Fang, Pinhao; Xiao, Xin; Zhang, Hanlu; Yuan, Yong

doi:10.3390/cancers14153721

Cited by 5 publications

(5 citation statements)

References 24 publications

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“…These findings suggest that the administration of adjuvant therapy had a detrimental impact on recurrence-free survival following nICT and the unnecessity of AT in this patient population. This aligns with prior research indicating patients receiving adjuvant therapy exhibited a significantly diminished disease-free survival following resection and neoadjuvant chemoradiation, in comparison to those not undergoing adjuvant therapy ( 22 ).…”

Section: Discussionsupporting

confidence: 89%

Adjuvant therapy provides no additional recurrence-free benefit for esophageal squamous cell carcinoma patients after neoadjuvant chemoimmunotherapy and surgery: a multi-center propensity score match study

Xie,

Yang,

Zhang

et al. 2024

Front. Immunol.

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PurposeThe need for adjuvant therapy (AT) following neoadjuvant chemoimmunotherapy (nICT) and surgery in esophageal squamous cell cancer (ESCC) remains uncertain. This study aims to investigate whether AT offers additional benefits in terms of recurrence-free survival (RFS) for ESCC patients after nICT and surgery.MethodsRetrospective analysis was conducted between January 2019 and December 2022 from three centers. Eligible patients were divided into two groups: the AT group and the non-AT group. Survival analyses comparing different modalities of AT (including adjuvant chemotherapy and adjuvant chemoimmunotherapy) with non-AT were performed. The primary endpoint was RFS. Propensity score matching(PSM) was used to mitigate inter-group patient heterogeneity. Kaplan-Meier survival curves and Cox regression analysis were employed for recurrence-free survival analysis.ResultsA total of 155 nICT patients were included, with 26 patients experiencing recurrence. According to Cox analysis, receipt of adjuvant therapy emerged as an independent risk factor(HR:2.621, 95%CI:[1.089,6.310], P=0.032), and there was statistically significant difference in the Kaplan-Meier survival curves between non-AT and receipt of AT in matched pairs (p=0.026). Stratified analysis revealed AT bring no survival benefit to patients with pathological complete response(p= 0.149) and residual tumor cell(p=0.062). Subgroup analysis showed no significant difference in recurrence-free survival between non-AT and adjuvant chemoimmunotherapy patients(P=0.108). However, patients receiving adjuvant chemotherapy exhibited poorer recurrence survival compared to non-AT patients (p= 0.016).ConclusionIn terms of recurrence-free survival for ESCC patients after nICT and surgery, the necessity of adjuvant therapy especially the adjuvant chemotherapy, can be mitigated.

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Section: Discussionsupporting

confidence: 89%

Adjuvant therapy provides no additional recurrence-free benefit for esophageal squamous cell carcinoma patients after neoadjuvant chemoimmunotherapy and surgery: a multi-center propensity score match study

Xie,

Yang,

Zhang

et al. 2024

Front. Immunol.

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“…Also, some studies have found no difference in disease-free survival or overall survival in cohorts receiving adjuvant chemotherapy [21]. The results of a retrospective study that included 447 patients suggest that adjuvant therapy is not recommended for patients with ESCC after neoadjuvant radiotherapy and esophagectomy, especially in patients without lymph node metastases after neoadjuvant therapy [22]. Therefore, more prospective studies are needed to con rm the e cacy of neoadjuvant and adjuvant chemotherapy in patients with pT1 ~ 2 ESCC.…”

Section: Discussionmentioning

confidence: 99%

Development and validation of a survival prediction model for patients with esophageal squamous cell carcinoma of the thoracic segment with pT1-2 lymph node metastasis

Lei,

Ma,

Jiang

et al. 2023

Preprint

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Background: Research on predicting disease-specific survival (DSS) in patients with esophageal squamous cell carcinoma (ESCC) of the thoracic segment with pT1 to 2 lymph node metastases is insufficient. The nomogram is an excellent tool for individualized assessment. Methods: A total of 146 patients from Harbin Medical University Cancer Hospital were included in the training cohort. 478 patients from the SEER database were included in the validation cohort. Independent risk factors were analyzed through Cox proportional hazards regression, and a nomogram was developed to predict 3- and 5-year DSS. Prognostic efficacy was evaluated using area under the curve (AUC), calibration curves, and decision curve analysis (DCA) and validated in the SEER validation cohort. Results: In the training cohort of 146 cases, the median DSS and IQR (Q1-Q3) for patients with lymph node metastasis was 30.5 months (16.1-67.4 months). In the validation cohort of 478 cases, the median DSS and IQR (Q1-Q3) for patients with lymph node metastasis was 22 months (9-63 months). Predictors of DSS were identified using Cox univariate and multivariate analyses, with pT stage, grade, and chemotherapy identified as significant factors. Conclusion: We created a nomogram. Internal and external validation studies were performed. The time-dependent receiver operating characteristic (ROC) curve and AUC value, calibration curve, and DCA confirmed the high predictive ability of the nomogram. The newly developed nomogram can accurately forecast DSS in patients with thoracic segment ESCC and pT1-2 lymph node metastasis.

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“…Reviews, monographs, textbooks, case reports, and non-English-written or non-full-text publications were rejected. Study selection criteria were as follows: (1) original articles published from 2013 to 2023, (2) primary tumor localization in the thoracic esophagus, (3) squamous cell carcinoma, (4) available characteristics of studied groups (age, sex, T, N, M, stage), (5) detailed description of curative procedures (radiation therapy, chemotherapy, surgery), (6) information about overall survival, (7) all patients received neoadjuvant therapy followed by esophagectomy.…”

Section: Meta-analysismentioning

confidence: 99%

“…In accordance with national and international clinical guidelines, neoadjuvant chemoradiotherapy (nCRT) is recommended as an option to improve treatment outcomes of thoracic esophageal squamous cell carcinoma (TESCC). As this modality improves survival, it has been reviewed in many recently published papers [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

Neoadjuvant chemoradiotherapy for thoracic esophageal squamous cell carcinoma: does everyone need it?

Chichevatov,

Sinev,

Glukhov

et al. 2024

Sib. onkol. ž.

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Objective. In accordance with clinical guidelines, neoadjuvant chemoradiotherapy (nCRT) is recommended as a beneficial option for treatment of thoracic esophageal squamous cell carcinoma (TESCC). However, some studies did not demonstrate potential benefits of nCRT. In this paper we compared treatment outcomes of surgery alone with preoperative CRT followed by surgery. Material and methods. Group 1 (n=147) consisted of patients who underwent surgery alone. Group 2 (n=3,337) was formed in the framework of the present systematic review and meta-analysis (15 publications captured 20 separate subgroups for analysis). Patients of group 2 received nCRT followed by esophagectomy. Overall survival (OS) and median OS were estimated. Results. The median OS was reached in group 1 and in 12 separate subgroups of group 2 (2310 of 3337 patients). In groups 1 and 2 the OS median estimates were 31.0 and 28.1, respectively (p=0.873). Respective 3-year and 5-year OS were 0.49 vs 0.48 (p=0.425) and 0.37 vs 0.41 (p=0.228). The median OS was not reached in 8 separate subgroups of group 2 (1027 of 3337 patients). In this case, group 2 patients had significantly higher 3- and 5-year OS compared to group 1 patients: 0.69 vs 0.49 (p=0.000) and 0.60 vs 0.37 (p=0.000), respectively. Pathological complete response to nCRT was associated with better survival. conclusion. nCRT is not appropriate for all patients with TESCC. Improved overall survival may be achieved in patients with a high grade of pathological tumor response to neoadjuvant treatment. Selective administration of nCRT based on highly probable prediction of complete tumor response seems promising. This concept needs further research.

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Trimodal Therapy in Esophageal Squamous Cell Carcinoma: Role of Adjuvant Therapy Following Neoadjuvant Chemoradiation and Surgery

Cited by 5 publications

References 24 publications

Adjuvant therapy provides no additional recurrence-free benefit for esophageal squamous cell carcinoma patients after neoadjuvant chemoimmunotherapy and surgery: a multi-center propensity score match study

Adjuvant therapy provides no additional recurrence-free benefit for esophageal squamous cell carcinoma patients after neoadjuvant chemoimmunotherapy and surgery: a multi-center propensity score match study

Development and validation of a survival prediction model for patients with esophageal squamous cell carcinoma of the thoracic segment with pT1-2 lymph node metastasis

Neoadjuvant chemoradiotherapy for thoracic esophageal squamous cell carcinoma: does everyone need it?

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