title: The role of postoperative adjuvant chemotherapy for lymph node-positive esophageal squamous cell carcinoma: a propensity score matching analysis.
abstract: The prognosis of patients with lymph node-positive esophageal squamous cell carcinoma (ESCC) who primarily receive radical esophagectomy remains poor. In this study, we aimed to retrospectively investigate the role of postoperative adjuvant chemotherapy with docetaxel- or paclitaxel-based regimens in these patients. A total of 434 consecutive patients were included in this study who underwent radical esophagectomy and were pathologically confirmed to have lymph node-positive ESCC from January 2005 to December 2010 in our institution. Among these patients, 113 patients received postoperative adjuvant chemotherapy (Group SC), and 321 patients underwent surgery alone (Group S). Propensity score matching and multivariate analyses were used to compensate for differences in some baseline characteristics. After matching, Group SC had significantly longer median disease-free survival (DFS) than that in Group S (23.63 months vs. 16.70 months; p = 0.006); further subset analysis revealed that a benefit regarding DFS was only associated with patients with N1 stage and with tumor length <4.5 cm. The median overall survival (OS) was similar between the two groups (38.57 months for Group SC vs. 25.27 months for Group S; p = 0.05). Multivariate analysis showed that postoperative chemotherapy, length of the tumor, T status, and N category were significantly independent predictive factors of tumor recurrence (p < 0.05). Our data suggested that adjuvant chemotherapy with docetaxel- or paclitaxel-based regimens could significantly improve DFS for patients with N1 stage and tumor length <4.5 cm ESCC and that it could potentially prolong OS for patients with lymph node-positive ESCC after surgery, compared with surgery alone. These results warrant further confirmation in prospective, randomized trials.
authors.affiliation: Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, No. 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, People's Republic of China.|State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, No. 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, People's Republic of China.
authors.forename: Rong-Qing
authors.initials: RQ
authors.lastname: Qin
authors.affiliation: Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, No. 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, People's Republic of China.|State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, No. 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, People's Republic of China.
authors.forename: Ying-Sheng
authors.initials: YS
authors.lastname: Wen
authors.affiliation: Department of Thoracic Surgery, Tangdu Hospital, the Fourth Military Medical University, Xi'an, 710038, Shaanxi, People's Republic of China.
authors.forename: Wu-Ping
authors.initials: WP
authors.lastname: Wang
authors.affiliation: Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, No. 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, People's Republic of China.|State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, No. 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, People's Republic of China.
authors.forename: Ke-Xing
authors.initials: KX
authors.lastname: Xi
authors.affiliation: Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, No. 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, People's Republic of China.|State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, No. 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, People's Republic of China.
authors.forename: Xiang-Yang
authors.initials: XY
authors.lastname: Yu
authors.affiliation: Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, No. 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, People's Republic of China. zhanglj@sysucc.org.cn.|State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, No. 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, People's Republic of China. zhanglj@sysucc.org.cn.
authors.forename: Lan-Jun
authors.initials: LJ
authors.lastname: Zhang
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects / Q000379:methods*; D018572:Disease-Free Survival; D000077143:Docetaxel; D004938:Esophageal Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D000077277:Esophageal Squamous Cell Carcinoma; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis / Q000473:pathology; D008297:Male; D008875:Middle Aged; D017239:Paclitaxel / Q000008:administration & dosage; D011184:Postoperative Period; D057216:Propensity Score; D012189:Retrospective Studies; D043823:Taxoids / Q000008:administration & dosage; D016896:Treatment Outcome
chemical_list: D043823:Taxoids; D000077143:Docetaxel; D017239:Paclitaxel
keywords: Esophageal squamous cell carcinoma; Lymph node-positive; Postoperative adjuvant chemotherapy; Prognosis