title: A Propensity-matched Analysis Comparing Survival After Esophagectomy Followed by Adjuvant Chemoradiation to Surgery Alone for Esophageal Squamous Cell Carcinoma.
abstract: The role of adjuvant chemoradiation in esophageal cancer has been underestimated in the literature. This study was undertaken to determine whether adjuvant chemoradiation improves survival compared with surgery alone.
  
  
  
  Data of 1095 esophageal squamous cell carcinoma (ESCC) patients, including 679 in surgery alone group (group 1) and 416 in surgery followed adjuvant chemoradaition group (group 2), were obtained from the Taiwan Cancer Registry database. Propensity score matching (PSM) analysis was used to identify 147 well-balanced patients in each group for overall survival comparison.
  
  
  
  After PSM, the 3-year survival rates and median survival were 44.9% and 27.2 (95% confidence interval [CI]: 17.6-40.3) months in group 2, which is significantly higher than that in group 1 (28.1% and 18.2 [95% CI: 14.3-24.5] months, P = 0.0043). In the multivariate survival analysis, pT3/4 stage (Hazard Ratio [HR]: 2.03, 95% CI: 1.38-2.97, P < 0.001), pN+ stage (HR: 1.83, 95% CI: 1.31-2.57, P = 0.0004), tumor length more than 32 mm (HR: 1.93, 95% CI: 1.33-2.79, P < 0.001), R1/2 resection (HR: 1.75, 95% CI: 1.15-2.66, P = 0.009), and adjuvant chemoradiation (HR: 0.57, 95% CI: 0.42-0.78, P < 0.0001) were independent prognostic factors. Subgroup analysis suggested patients with pT3/4 stage, pN+ stage tumors, larger tumor size, poorly differentiated tumors, and R1/2 resections were more likely to demonstrate survival benefit from adjuvant chemoradiation.
  
  
  
  Compared with surgery alone, adjuvant chemoradiation provides a survival benefit to ESCC patients, especially those with pT3/4 stage, N+ tumors, larger tumor size, poorly differentiated tumors, and R1/2 resections.
authors.affiliation: *Department of Surgery, Division of Chest Surgery, Taipei Veterans General Hospital , Taipei, Taiwan†School of Medicine National Yang-Ming University, Taipei, Taiwan‡Institute of Health and Welfare Policy, National Yang-Ming University, Taipei , Taiwan§Division of Thoracic Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan¶Department of Surgery, Division of Thoracic Surgery, Changhua Christian Hospital, Taichung, Taiwan||Department of Surgery, Division of Thoracic Surgery, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan.
authors.forename: Jwu-Yun
authors.initials: JY
authors.lastname: Hwang
authors.forename: Hui-Shan
authors.initials: HS
authors.lastname: Chen
authors.forename: Po-Kuei
authors.initials: PK
authors.lastname: Hsu
authors.forename: Yin-Kai
authors.initials: YK
authors.lastname: Chao
authors.forename: Bing-Yen
authors.initials: BY
authors.lastname: Wang
authors.forename: Chien-Sheng
authors.initials: CS
authors.lastname: Huang
authors.forename: Chia-Chuan
authors.initials: CC
authors.lastname: Liu
authors.forename: Shiao-Chi
authors.initials: SC
authors.lastname: Wu
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000628:therapy*; D059186:Chemoradiotherapy, Adjuvant / Q000379:methods; D004938:Esophageal Neoplasms / Q000401:mortality / Q000628:therapy*; D000077277:Esophageal Squamous Cell Carcinoma; D016629:Esophagectomy / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011182:Postoperative Care / Q000379:methods; D057216:Propensity Score; D012042:Registries; D012189:Retrospective Studies; D016019:Survival Analysis; D013624:Taiwan; D016896:Treatment Outcome