Impact of the interval between neoadjuvant concurrent chemoradiotherapy and esophagectomy in the modern era: a population-based propensity-score-matched retrospective cohort study in Asia

World J Surg Oncol. 2019 Dec 19;17(1):222. doi: 10.1186/s12957-019-1712-7.

Abstract

Background: Neoadjuvant concurrent chemoradiotherapy (nCCRT) is one of the standard-of-care options for locally advanced esophageal squamous cell carcinoma (LA-ESqCC). The optimal interval between nCCRT and esophagectomy is unknown.

Methods: We constructed a propensity-score-matched [1:1 for long (8-12 weeks) vs short (4-7 weeks) intervals] cohort of LA-ESqCC patients who were diagnosed from 2011 to 2015 and treated with nCCRT via the Taiwan Cancer Registry and related databases. We compared the hazard ratios (HRs) of death using a robust variance estimator. We also evaluated alternative covariables, outcomes, and interval definitions.

Results: Our study population included 80 patients for each group; groups were balanced with respect to the observed covariables. There was no significant difference for the HR of death [1.22; 95% confidence interval 0.78-1.91, P = 0.39] when the long interval group was compared to the short interval group. There were also no significant differences when alternative covariables, outcomes, or interval definitions were evaluated.

Conclusions: In this population-based study in modern Asia, we found that for LA-ESqCC patients treated with nCCRT and esophagectomy, overall survival was similar for either long or short intervals between nCCRT and esophagectomy. Randomized controlled trials are needed to verify this finding.

Keywords: Esophageal squamous cell carcinoma; Esophagectomy; Interval; Neoadjuvant concurrent chemoradiotherapy.

MeSH terms

  • Asia / epidemiology
  • Chemoradiotherapy
  • Chemoradiotherapy, Adjuvant
  • Cohort Studies
  • Esophageal Neoplasms / mortality*
  • Esophageal Neoplasms / pathology
  • Esophageal Neoplasms / therapy*
  • Esophageal Squamous Cell Carcinoma / mortality*
  • Esophageal Squamous Cell Carcinoma / pathology
  • Esophageal Squamous Cell Carcinoma / therapy
  • Esophagectomy / mortality*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neoadjuvant Therapy
  • Propensity Score
  • Retrospective Studies
  • Survival Rate
  • Time-to-Treatment
  • Treatment Outcome