Survival outcomes of the use of adjuvant chemotherapy in resected esophagus cancer after neoadjuvant chemoradiotherapy
Menée à l'aide de données 2008-2018 de l'Assurance maladie taïwannaise et du registre taïwannais des cancers portant sur 1 212 patients atteints d'un cancer de l'oesophage, cette étude analyse l'intérêt, du point de vue du taux de mortalité à 5 ans, d'ajouter une chimiothérapie après une chimioradiothérapie et une chirurgie
Introduction: Neoadjuvant chemoradiotherapy (nCRT) followed by surgery is the standard treatment for esophageal cancer, but the role of adjuvant chemotherapy remains unclear. This study investigates the survival benefits of adjuvant chemotherapy in patients undergoing nCRT and surgery.
Methods: A total of 1,212 esophageal cancer patients who underwent nCRT and surgery, with or without adjuvant chemotherapy, between January 2008 and December 2018 were identified from the Taiwan Cancer Registry and National Health Insurance Research Database. The Cox regression analysis was utilized to evaluate the impact of adjuvant chemotherapy on 5-year mortality rates.
Results: Of the 1,212 patients, 276 (22.8%) received adjuvant chemotherapy, while 936 (77.2%) did not. The most used chemotherapy regimens were cisplatin and 5-FU. Younger age (<60 years), advanced pathological tumor stage (ypT3-4), and nodal involvement (ypN1-3) were significantly associated with the use of adjuvant chemotherapy. Survival analysis showed that patients receiving adjuvant chemotherapy had worse survival outcomes in comparison to those who did not, 99/276 (35.87%) and 417/936 (44.55%), but without statistical significance after multivariable Cox regression analysis (adjusted hazard ratio [aHR], 1.11; 95% Confidence Interval [CI], 0.93–1.33). Stratified analysis of 5-year mortality also failed to demonstrate a protective effect of adjuvant chemotherapy, even in patients with advanced clinical T or N classification.
Conclusions: Adjuvant chemotherapy provides limited survival benefit for esophageal cancer patients following nCRT and surgery. Alternative strategies, such as immune checkpoint inhibitors or their combination with chemotherapy, should be explored.
European Journal of Surgical Oncology , article en libre accès, 2025