title: Survival benefits of postoperative chemoradiation for lymph node-positive esophageal squamous cell carcinoma.
abstract: BACKGROUND
  Little is known about the efficacy of chemoradiation therapy after surgery for patients with esophageal squamous cell carcinoma. This retrospective study aimed to determine whether postoperative chemoradiation improves survival compared with surgery alone.
  
  
  METHODS
  Of 290 patients with esophageal squamous cell carcinoma, 104 received postoperative chemoradiation therapy (CRT group) and 186 underwent surgery alone (S group). Propensity score matching analysis was used to identify 56 well-balanced pairs of patients to compare outcomes.
  
  
  RESULTS
  For N0 patients, overall survival (OS) and disease-free survival (DFS) were similar in both groups. For N+ patients, the median OS (31.0 versus 16.0 months) and the 3-year OS rate (45.8% versus 14.1%) were significantly higher in the CRT group than in the S group (p<0.001). Similarly, the median DFS (16.0 versus 9.0 months) and the 3-year DFS rate (24.1% versus 11.5%) were significantly higher in the CRT group than in the S group (p=0.002). In propensity-matched patients, a survival benefit was observed for N+ patients receiving postoperative chemoradiation (CRT versus S group: median OS 29.0 versus 16.0 months, 3-year OS rate 48.6% versus 16.8%; p=0.003). Disease-free survival (median DFS 11.0 versus 8.0 months, 3-year DFS rate 21.3% versus 12.5%) tended to be better in the CRT group than in the S group (p=0.057).
  
  
  CONCLUSIONS
  Postoperative chemoradiation therapy provided a survival benefit for patients with lymph node-positive esophageal squamous cell carcinoma.
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan. Electronic address: hsupokuei@yahoo.com.tw.
authors.forename: Po-Kuei
authors.initials: PK
authors.lastname: Hsu
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Chien-Sheng
authors.initials: CS
authors.lastname: Huang
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Changhua Christian Hospital, Taichung, Taiwan.
authors.forename: Bing-Yen
authors.initials: BY
authors.lastname: Wang
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Yu-Chung
authors.initials: YC
authors.lastname: Wu
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Wen-Hu
authors.initials: WH
authors.lastname: Hsu
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000401:mortality* / Q000556:secondary / Q000628:therapy*; D059248:Chemoradiotherapy / Q000379:methods*; D015331:Cohort Studies; D018572:Disease-Free Survival; D004938:Esophageal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D016629:Esophagectomy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D011182:Postoperative Care / Q000379:methods; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D013624:Taiwan; D013997:Time Factors; D016896:Treatment Outcome