Tolerability, toxicity, and outcomes following surgical and non-surgical approaches to the management of patients with locally advanced oesophageal squamous cell carcinoma: multicentre retrospective cohort study

Abstract

Background: Oesophageal squamous cell carcinoma is the predominant histopathological subtype of oesophageal cancer across the world, representing as many as 90% of all cases; however, within Western cohorts, it is a low-prevalence disease, and, as such, appropriately powered trials to establish a standard treatment paradigm in this population remain challenging. The aim of this study was to assess current practices and compare outcomes for patients with locally advanced oesophageal squamous cell carcinoma across the UK and Ireland.

Methods: This was a retrospective multicentre cohort study of patients managed with curative intent for squamous cell carcinoma of the middle or distal oesophagus in 23 hospitals across the UK and Ireland. Consecutive patients diagnosed between 1 January 2012 and 31 December 2016 were included.

Results: This study included 1545 patients, of whom 923 (59.7%) received definitive chemoradiotherapy, 286 (18.5%) neoadjuvant chemotherapy + surgery, 218 (14.1%) neoadjuvant chemoradiotherapy + surgery, and 118 (7.6%) surgery alone. Neoadjuvant chemoradiotherapy + surgery was associated with significantly longer survival than neoadjuvant chemotherapy or definitive chemoradiotherapy (median 83.9 versus 27.8 versus 26.5 months). In propensity score-matched analysis of overall survival, patients receiving neoadjuvant chemoradiotherapy + surgery had significantly longer survival than those who had definitive chemoradiotherapy (median 56.8 versus 43.1 months; hazard ratio 0.39, 95% confidence interval 0.20 to 0.78; P < 0.001).

Conclusion: This multicentre retrospective cohort study suggests that, despite a majority of patients being treated with definitive chemoradiotherapy, patients undergoing neoadjuvant chemoradiotherapy and surgery have improved survival compared with those receiving definitive chemoradiotherapy or neoadjuvant chemotherapy + surgery. In the absence of robust Western randomized clinical trial data, neoadjuvant chemoradiotherapy + surgery should be considered the standard for well selected patients fit for surgery.