Perioperative chemotherapy versus preoperative chemoradiotherapy in resectable esophageal cancer: A real-world analysis.

Abstract

e16163 Background: Nonmetastatic esophageal cancer (EC) is treated with radical surgery. To improve survival rates and prevent recurrence, patients typically receive either perioperative chemotherapy (Peri-CT) or preoperative chemoradiotherapy (Pre-CRT). This study aims to compare these two modalities in real-world settings. Methods: Using the Surveillance, Epidemiology, and End Results (SEER) database, we have queried all adult patients diagnosed with esophageal carcinoma regardless of histological origin from 2007 to 2021. Inclusion criteria encompassed esophageal cancer patients of all anatomical sites (cervical, thoracic, upper, middle, and lower third of the esophagus). Patients with distant metastasis were excluded from the study. Variables collected were sex, race, histological subtype (squamous cell vs adenocarcinoma), disease stage (localized vs regional). Main study outcomes were overall survival (OS) and cancer-specific survival (CSS). Univariate and multivariable cox proportional hazards model was used to produce hazard ratios (HR). Results: We analyzed 3,811 EC patients. Of which, 3,060 (80.3%) patients were treated with Pre-CRT and 751 (19.7%) patients were treated with Peri-CT. Most patients had a regional disease (83%) and 17% of patients had a localized disease. Median OS and CSS were 22 (95% CI: 21 to 23) and 20 (95% CI: 20 to 21) months (Table). In univariate analysis, Peri-CT group achieved favorable OS (HR: 0.39, 95% CI: 0.36 to 0.44) and CSS (HR: 0.32, 95% CI: 0.28 to 0.36) outcomes compared to PreOP-CRT. As for multivariable analysis, this effect remained consistent in favor of Peri-CT for OS (HR: 0.40, 95% CI: 0.36 to 0.45) and CSS (HR: 0.32, 95% CI: 0.28 to 0.36) after taking sex, histological subtype, and staging into consideration. Subgroup analysis of disease staging showed that patients with localized disease have a larger survival benefit (HR: 0.28, 95% CI: 0.22 to 0.36) than patients with regional disease (HR: 0.43, 95% CI: 0.39 to 0.48) from Peri-CT compared to Pre-CRT. Conclusions: Peri-CT offers better OS and CSS for EC patients compared to Pre-CRT. This represents one of the largest database analyses conducted to date, with findings consistent with the recently published ESOPEC trial. Comparing median overall and cancer-specific survival and 1-year, 3-year, and 5-year rates between perioperative chemotherapy and preoperative chemoradiotherapy. Group OS CSS Median 1-y 3-y 5-y Median 1-y 3-y 5-y Peri-CT 41 80.8% 53.3% 39.9% 45 80.5% 53.8% 42.0% PreOP-CRT 20 69.5% 25.6% 0.59% 19 68.3% 20.0% 6.77% Total 22 71.7% 30.4% 16.3% 20 70.8% 26.3% 12.6%