Prognostic value of postoperative adjuvant chemotherapy in patients with cervical and upper thoracic esophageal squamous cell carcinoma_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

GUO Kang ¹ , MA Jie ² , ZHU Jianfei ² , BAI Junfeng ¹ ,  WANG Wuping ¹ , LU Qiang ² , ZHAO Jinbo ² , YAN Xiaolong ² , WANG Jian ² , LI Wenhai ¹ , LI Xiaofei ¹

1. Chest Hospital, Xi'an International Medical Center Hospital, Xi'an, 710100, P. R. China;
2. Department of Thoracic Surgery, Tangdu Hospital, Air Force Military Medical University, Xi'an, 710038, P. R. China;

Corresponding author：

WANG Wuping, Email: wwp._8@163.com

Keywords：

Cervical esophageal squamous cell carcinoma; upper thoracic esophageal squamous cell carcinoma; operation; adjuvant chemotherapy; prognosis

DOI：

10.7507/1007-4848.202101005

Video：

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Objective To explore whether surgery combined with adjuvant chemotherapy can bring survival benefits to patients with cervical and upper thoracic esophageal squamous cell carcinoma (ESCC).Methods The clinical data of patients with cervical and upper thoracic ESCC who underwent R0 resection and neck anastomosis in our department from 2006 to 2010 were retrospectively analyzed. Patients received neoadjuvant therapy or adjuvant radiotherapy were excluded. The adjuvant chemotherapy group was given a combination of taxanes and platinum based chemotherapy after surgery; the surgery alone group did not receive adjuvant chemotherapy. The Kaplan-Meier method was used to analyze the survival difference between the adjuvant chemotherapy group and the surgery alone group. Results A total of 181 patients were enrolled, including 141 (77.9%) males and 40 (22.1%) females, with an average age of 61.0±8.2 years (80 patients aged≤61 years, 101 patients aged>61 years). There were 70 (38.7%) patients of cervical ESCC, and 111 (61.3%) patients of upper thoracic ESCC. Eighty-seven (48.1%) patients underwent postoperative adjuvant chemotherapy, and 94 (51.9%) patients underwent surgery alone, and the basic clinical characteristics were well balanced between the two groups (P>0.05). The median survival time of patients in the adjuvant chemotherapy group and the surgery alone group was 31.93 months and 26.07 months, and the 5-year survival rate was 35.0% and 32.0%, respectively (P=0.227). There was no statistical difference in median survival time between the cervical ESCC and upper thoracic ESCC group (31.83 months vs. 29.76 months, P=0.763). For cervical ESCC patients, the median survival time was 45.07 months in the adjuvant chemotherapy group and 14.70 months in the surgery alone group (P=0.074). Further analysis showed that the median survival time of lymph node negative group was 32.53 months, and the lymph node positive group was 24.57 months (P=0.356). The median survival time was 30.43 months in the lymph-node positive group with adjuvant chemotherapy and 17.77 months in the lymph-node positive group with surgery alone. The survival curve showed a trend of difference, but the difference was not statistically significant (P=0.557).Conclusion There is no statistical difference in the long-term survival of cervical and upper thoracic ESCC patients after R0 resection. Postoperative adjuvant chemotherapy may have survival benefits for patients with cervical ESCC and upper ESCC with postoperative positive lymph nodes, but the differences are not statistically significant in this setting.

Citation： GUO Kang, MA Jie, ZHU Jianfei, BAI Junfeng, WANG Wuping, LU Qiang, ZHAO Jinbo, YAN Xiaolong, WANG Jian, LI Wenhai, LI Xiaofei. Prognostic value of postoperative adjuvant chemotherapy in patients with cervical and upper thoracic esophageal squamous cell carcinoma. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(12): 1580-1586. doi: 10.7507/1007-4848.202101005 Copy

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2.	Edge SB, Compton CC. The American Joint Committee on Cancer: The 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol, 2010, 17(6): 1471-1474.
3.	Rice TW. Esophageal cancer staging. Korean J Thorac Cardiovasc Surg, 2015, 48(3): 157-163.
4.	Nakahara R, Kodaira T, Furutani K, et al. Treatment outcomes of definitive chemoradiotherapy for patients with hypopharyngeal cancer. J Radiat Res, 2012, 53(6): 906-915.
5.	Cooper JS, Guo MD, Herskovic A, et al. Chemoradiotherapy of locally advanced esophageal cancer: Long-term follow-up of a prospective randomized trial (RTOG 85-01). Radiation Therapy Oncology Group. JAMA, 1999, 281(17): 1623-1627.
6.	Buckstein M, Liu J. Cervical esophageal cancers: Challenges and opportunities. Curr Oncol Rep, 2019, 21(5): 46.
7.	Wang WP, Ma J, Lu Q, et al. Larynx-preserving limited resection with total thoracic esophagectomy and gastric pull-up reconstruction: A promising treatment for selected cervical esophageal squamous cell carcinoma. Turk J Gastroenterol, 2020, 31(12): 948-954.
8.	Saeki H, Sohda M, Sakai M, et al. Role of surgery in multidisciplinary treatment strategies for locally advanced esophageal squamous cell carcinoma. Ann Gastroenterol Surg, 2020, 4(5): 490-497.
9.	国家卫生健康委员会. 食管癌诊疗规范(2018年版). 《中华消化病与影像杂志（电子版）》, 2019, 9 (4): 158-192.
10.	Smalley SR, Benedetti JK, Haller DG, et al. Updated analysis of SWOG-directed intergroup study 0116: A phase Ⅲ trial of adjuvant radiochemotherapy versus observation after curative gastric cancer resection. J Clin Oncol, 2012, 30(19): 2327-2333.
11.	Noh SH, Park SR, Yang HK, et al. Adjuvant capecitabine plus oxaliplatin for gastric cancer after D2 gastrectomy (CLASSIC): 5-year follow-up of an open-label, randomised phase 3 trial. Lancet Oncol, 2014, 15(12): 1389-1396.
12.	赫捷. 食管癌规范化诊治指南(第2版). 中国协和医科大学出版社, 2013.
13.	Zhao L, Zhou Y, Mu Y, et al. Patterns of failure and clinical outcomes of definitive radiotherapy for cervical esophageal cancer. Oncotarget, 2017, 8(13): 21852-21860.
14.	Chou SH, Li HP, Lee JY, et al. Radical resection or chemoradiotherapy for cervical esophageal cancer? World J Surg, 2010, 34(8): 1832-1839.
15.	Kikuchi H, Takeuchi H. Future perspectives of surgery for esophageal cancer. Ann Thorac Cardiovasc Surg, 2018, 24(5): 219-222.
16.	Cao CN, Luo JW, Gao L, et al. Primary radiotherapy compared with primary surgery in cervical esophageal cancer. JAMA Otolaryngol Head Neck Surg, 2014, 140(10): 918-926.
17.	Pöttgen C, Stuschke M. Radiotherapy versus surgery within multimodality protocols for esophageal cancer — A meta-analysis of the randomized trials. Cancer Treat Rev, 2012, 38(6): 599-604.
18.	Grass GD, Cooper SL, Armeson K, et al. Cervical esophageal cancer: A population-based study. Head Neck, 2015, 37(6): 808-814.
19.	王武平, 马洁, 张继朋, 等. 颈段食管鳞癌与胸上段食管鳞癌外科治疗比较的倾向性评分匹配分析. 中国胸心血管外科临床杂志, 2021, 28(6): 706-713.
20.	Zhang J, Zhang W, Zhang B, et al. Clinical results of intensity-modulated radiotherapy for 250 patients with cervical and upper thoracic esophageal carcinoma. Cancer Manag Res, 2019, 11: 8285-8294.
21.	Saeki H, Tsutsumi S, Yukaya T, et al. Clinicopathological features of cervical esophageal cancer: Retrospective analysis of 63 consecutive patients who underwent surgical resection. Ann Surg, 2017, 265(1): 130-136.
22.	Ando N, Iizuka T, Ide H, et al. Surgery plus chemotherapy compared with surgery alone for localized squamous cell carcinoma of the thoracic esophagus: A Japan Clinical Oncology Group Study—JCOG9204. J Clin Oncol, 2003, 21(24): 4592-4596.
23.	Nomura M, Oze I, Abe T, et al. Impact of docetaxel in addition to cisplatin and fluorouracil as neoadjuvant treatment for resectable stage Ⅲ or T3 esophageal cancer: A propensity score-matched analysis. Cancer Chemother Pharmacol, 2015, 76(2): 357-363.
24.	Wang T, Yu J, Liu M, et al. The benefit of taxane-based therapies over fluoropyrimidine plus platinum (FP) in the treatment of esophageal cancer: A meta-analysis of clinical studies. Drug Des Devel Ther, 2019, 13: 539-553.

1. Denham JW, Burmeister BH, Lamb DS, et al. Factors influencing outcome following radio-chemotherapy for oesophageal cancer. The Trans Tasman Radiation Oncology Group (TROG). Radiother Oncol, 1996, 40(1): 31-43.
2. Edge SB, Compton CC. The American Joint Committee on Cancer: The 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol, 2010, 17(6): 1471-1474.
3. Rice TW. Esophageal cancer staging. Korean J Thorac Cardiovasc Surg, 2015, 48(3): 157-163.
4. Nakahara R, Kodaira T, Furutani K, et al. Treatment outcomes of definitive chemoradiotherapy for patients with hypopharyngeal cancer. J Radiat Res, 2012, 53(6): 906-915.
5. Cooper JS, Guo MD, Herskovic A, et al. Chemoradiotherapy of locally advanced esophageal cancer: Long-term follow-up of a prospective randomized trial (RTOG 85-01). Radiation Therapy Oncology Group. JAMA, 1999, 281(17): 1623-1627.
6. Buckstein M, Liu J. Cervical esophageal cancers: Challenges and opportunities. Curr Oncol Rep, 2019, 21(5): 46.
7. Wang WP, Ma J, Lu Q, et al. Larynx-preserving limited resection with total thoracic esophagectomy and gastric pull-up reconstruction: A promising treatment for selected cervical esophageal squamous cell carcinoma. Turk J Gastroenterol, 2020, 31(12): 948-954.
8. Saeki H, Sohda M, Sakai M, et al. Role of surgery in multidisciplinary treatment strategies for locally advanced esophageal squamous cell carcinoma. Ann Gastroenterol Surg, 2020, 4(5): 490-497.
9. 国家卫生健康委员会. 食管癌诊疗规范(2018年版). 《中华消化病与影像杂志（电子版）》, 2019, 9 (4): 158-192.
10. Smalley SR, Benedetti JK, Haller DG, et al. Updated analysis of SWOG-directed intergroup study 0116: A phase Ⅲ trial of adjuvant radiochemotherapy versus observation after curative gastric cancer resection. J Clin Oncol, 2012, 30(19): 2327-2333.
11. Noh SH, Park SR, Yang HK, et al. Adjuvant capecitabine plus oxaliplatin for gastric cancer after D2 gastrectomy (CLASSIC): 5-year follow-up of an open-label, randomised phase 3 trial. Lancet Oncol, 2014, 15(12): 1389-1396.
12. 赫捷. 食管癌规范化诊治指南(第2版). 中国协和医科大学出版社, 2013.
13. Zhao L, Zhou Y, Mu Y, et al. Patterns of failure and clinical outcomes of definitive radiotherapy for cervical esophageal cancer. Oncotarget, 2017, 8(13): 21852-21860.
14. Chou SH, Li HP, Lee JY, et al. Radical resection or chemoradiotherapy for cervical esophageal cancer? World J Surg, 2010, 34(8): 1832-1839.
15. Kikuchi H, Takeuchi H. Future perspectives of surgery for esophageal cancer. Ann Thorac Cardiovasc Surg, 2018, 24(5): 219-222.
16. Cao CN, Luo JW, Gao L, et al. Primary radiotherapy compared with primary surgery in cervical esophageal cancer. JAMA Otolaryngol Head Neck Surg, 2014, 140(10): 918-926.
17. Pöttgen C, Stuschke M. Radiotherapy versus surgery within multimodality protocols for esophageal cancer — A meta-analysis of the randomized trials. Cancer Treat Rev, 2012, 38(6): 599-604.
18. Grass GD, Cooper SL, Armeson K, et al. Cervical esophageal cancer: A population-based study. Head Neck, 2015, 37(6): 808-814.
19. 王武平, 马洁, 张继朋, 等. 颈段食管鳞癌与胸上段食管鳞癌外科治疗比较的倾向性评分匹配分析. 中国胸心血管外科临床杂志, 2021, 28(6): 706-713.
20. Zhang J, Zhang W, Zhang B, et al. Clinical results of intensity-modulated radiotherapy for 250 patients with cervical and upper thoracic esophageal carcinoma. Cancer Manag Res, 2019, 11: 8285-8294.
21. Saeki H, Tsutsumi S, Yukaya T, et al. Clinicopathological features of cervical esophageal cancer: Retrospective analysis of 63 consecutive patients who underwent surgical resection. Ann Surg, 2017, 265(1): 130-136.
22. Ando N, Iizuka T, Ide H, et al. Surgery plus chemotherapy compared with surgery alone for localized squamous cell carcinoma of the thoracic esophagus: A Japan Clinical Oncology Group Study—JCOG9204. J Clin Oncol, 2003, 21(24): 4592-4596.
23. Nomura M, Oze I, Abe T, et al. Impact of docetaxel in addition to cisplatin and fluorouracil as neoadjuvant treatment for resectable stage Ⅲ or T3 esophageal cancer: A propensity score-matched analysis. Cancer Chemother Pharmacol, 2015, 76(2): 357-363.
24. Wang T, Yu J, Liu M, et al. The benefit of taxane-based therapies over fluoropyrimidine plus platinum (FP) in the treatment of esophageal cancer: A meta-analysis of clinical studies. Drug Des Devel Ther, 2019, 13: 539-553.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Prognostic value of postoperative adjuvant chemotherapy in patients with cervical and upper thoracic esophageal squamous cell carcinoma

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