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Research Paper|Volume 15, Issue 8|pp 3158—3170

Association of survival with adjuvant radiotherapy for pN0 esophageal cancer

Huijiang Gao1, Yuanyong Wang2, Zhihui Jiang3, Guodong Shi1, Shiyu Hu1, Jiangshan Ai1, Zhaofeng Wang1, Yucheng Wei1
  • 1Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
  • 2Department of Thoracic Surgery, Tangdu Hospital of Air Force Military Medical University, Xi’an, China
  • 3Department of General Surgery, Qingdao Women and Children’s Hospital, Qingdao, China
* Equal contribution
Received: November 9, 2022Accepted: April 15, 2023Published: April 25, 2023
https://doi.org/10.18632/aging.204677

Copyright: © 2023 Gao et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Introduction: This study was conducted to elucidate the link between adjuvant radiotherapy and survival in pathologic node-negative (pN0) esophageal cancer patients with upfront esophagectomy.

Methods: From 2000 to 2016, patients with pN0 esophageal cancer who underwent upfront esophagectomy were selected from the Surveillance, Epidemiology, and End Results (SEER) database. The association of high-risk covariates with survival after adjuvant radiotherapy was evaluated using propensity score matching and multivariate analysis.

Results: We identified 3197 patients, 321 (10.0%) underwent postoperative radiotherapy and 2876 (90.0%) underwent esophagectomy alone. In the unmatched cohort, postoperative radiotherapy was associated with a statistically significant but modest absolute decrease in survival outcomes (P < 0.001). In the matched cohort, the survival differences disappeared. Additionally, adjuvant radiotherapy was linked to a 5-year overall survival (OS) benefit for patients with the pT3-4N0 disease (34.8% vs. 27.7%; P = 0.008). Adjuvant radiotherapy for pT3-4N0 disease with tumor length ≥3 cm, adenocarcinoma, and evaluated lymph node count <12 was shown to independently function as a risk factor for improved OS, as per a multivariate analysis (P < 0.01).

Conclusions: This population-based trial showed that high-risk patients with pT3-4N0 esophageal cancer had better OS following upfront esophagectomy followed by radiotherapy therapy. This discovery may have major significance in the use of adjuvant radiotherapy following upfront esophagectomy in patients with pN0 esophageal cancer.