Postoperative chemoradiotherapy improves survival in patients with stage II–III esophageal squamous cell carcinoma: An analysis of clinical outcomes

BACKGROUND We compared the efficacy of postoperative chemoradiation (POCRT) and surgery alone (SA) in patients with stage II-III esophageal squamous cell carcinoma (ESCC). METHODS We analyzed the records of 265 patients with stage II-III ESCC who had undergone transthoracic esophagectomy and lymphadenectomy; 105 patients received POCRT, while 160 had SA. RESULTS The median disease-free survival (DFS) of the whole cohort was 22 months (95% confidence interval [CI], 19.2-24.8), while the median overall survival (OS) was 29 months (95% CI 25.5-32.5). The median DFS of the SA group was 21 months (95% CI 17.9-24.0), while that of the POCRT group was 29 months (95% CI 18.8-31.2; P = 0.048). Consistently, patients in the POCRT group had significantly longer median OS than patients in the SA group (34 vs. 26 months, respectively). Subgroup analysis showed that in patients with positive lymph nodes, pathological stage III, T3-4 stage, and poorly differentiated carcinoma, POCRT was apparently more effective than SA at improving OS and decreasing the rates of local recurrence and distant metastasis. Multivariate analysis demonstrated that lymph node involvement and treatment with POCRT were independent prognostic factors. CONCLUSION Compared with SA, POCRT may be more effective in improving OS and decreasing the rates of local recurrence and distant metastasis, particularly in stage III or positive lymph node stage II-III ESCC patients.