Efficacy of chemoradiotherapy versus surgery in cervical esophageal cancer: a population-based competing risk analysis
Ji Guangqian1,2, Zhang Xiaoxiao1,2, Ma Zhenghui1,2, Fan Xinling1, Qi Shunan1,2, Yi Junlin1,2, Zhang Tao1,2
1Department of Radiation Oncology, National Cancer Center / National Clinical Research Center for Cancer/ Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China; 2Department of Radiation Oncology, National Cancer Center / National Clinical Research Center for Cancer / Hebei Cancer Hospital, Chinese Academy of Medical Sciences, Langfang 065001, China
Abstract：Objective To evaluate the value of chemoradiotherapy and surgery in cervical esophageal cancer (CEC). Methods Data of 459 patients with CEC from 2004 to 2017 were collected and retrospectively analyzed from the surveillance, epidemiology, and end results (SEER) database of National Cancer Institute (US). All patients were divided into the chemoradiotherapy group (n=379) and surgery group (n=80) according to the treatment methods. Survival analysis was performed by Kaplan-Meier method and survival curve was drawn. Multivariate survival analysis was conducted by Cox proportional hazards regression model. The death rate of different causes between two groups was calculated by cumulative incidence function (CIF). The differences of death rate between two groups were evaluated by Fine-Gray competing risk model. By analyzing the clinical characteristics and survival of CEC patients, the overall survival (OS) was compared between the surgery and chemoradiotherapy groups. Results The 2- and 5-year survival rates in the chemoradiotherapy group were 43.1% and 22.4%, while those of the surgical group were 46.8% and 26.0%, respectively. No significant difference was observed in the OS between the chemoradiotherapy and surgery groups (P=0.750). Cox multivariate analysis showed that treatment (surgery group vs. chemoradiotherapy group) was not an independent prognostic factor for OS. Based on the results of competing risk analysis, the risk of esophageal cancer-specific death in the chemoradiotherapy group was higher than that in the surgery group, and the difference was statistically significant between two groups (P<0.001). The risk of other cause-specific death in the chemoradiotherapy group was lower than that in the surgery group (P<0.001). The proportion of patients who died of oral, oropharyngeal, hypopharyngeal and laryngeal diseases in the surgery group was significantly higher than that in the chemoradiotherapy group(all P<0.001). Conclusions No significant difference is observed in the OS of CEC patients treated with chemoradiotherapy or surgery. In the surgery group, the risk of esophageal cancer-specific death is lower, whereas the risk of other cause-specific death is higher compared with those in the chemoradiotherapy group.
Ji Guangqian,Zhang Xiaoxiao,Ma Zhenghui et al. Efficacy of chemoradiotherapy versus surgery in cervical esophageal cancer: a population-based competing risk analysis[J]. Chinese Journal of Radiation Oncology, 2023, 32(6): 506-511.
[1] Mendenhall WM, Sombeck MD, Parsons JT, et al.Management of cervical esophageal carcinoma[J]. Semin Radiat Oncol, 1994,4(3):179-191. DOI: 10.1053/SRAO00400179. [2] Popescu CR, Bertesteanu SV, Mirea D, et al.The epidemiology of hypopharynx and cervical esophagus cancer[J]. J Med Life, 2010,3(4):396-401. [3] Grass GD, Cooper SL, Armeson K, et al.Cervical esophageal cancer: a population-based study[J]. Head Neck, 2015,37(6):808-814. DOI: 10.1002/hed.23678. [4] Buckstein M, Liu J.Cervical esophageal cancers: challenges and opportunities[J]. Curr Oncol Rep, 2019,21(5):46. DOI: 10.1007/s11912-019-0801-7. [5] Hoeben A, Polak J, Van De Voorde L, et al. Cervical esophageal cancer: a gap in cancer knowledge[J]. Ann Oncol, 2016,27(9):1664-1674. DOI: 10.1093/annonc/mdw183. [6] 中国医师协会放射肿瘤治疗医师分会, 中华医学会放射肿瘤治疗学分会, 中国抗癌协会肿瘤放射治疗专业委员会. 中国食管癌放射治疗指南(2021年版)[J].国际肿瘤学杂志,2022,49(1):12-25. DOI: 10.3760/cma.j.cn371439-2021 1021-00002. Chinese Medical Doctor Association Radiation Oncologist Branch, Chinese Medical Association Branch Of Radiation Oncology Therapy, Tumor Radiation Therapy Committee of Chinese Anti-Cancer Association. Chinese guidelines for radiotherapy of esophageal cancer (2021 edition)[J]. J Inter Oncol, 2022,49(1): 12-25. DOI: 10.3760/cma.j.cn371439-20211021-00002. [7] Condon HA.Anaesthesia for pharyngo-laryngo- oesophagectomy with pharyngo-gastrostomy[J]. Br J Anaesth, 1971,43(11):1061-1065. DOI: 10.1093/bja/43.11.1061. [8] Haguenauer JP, Pignat JC. Total pharyngo-laryngo- esophagectomy and reconstruction by gastric or colic pull up[J]. Auris Nasus Larynx, 1985,12 Suppl 2:S41-43. DOI: 10.1016/s0385-8146(85)80026-2. [9] Archibald S, Young JE, Thoma A. Pharyngo-cervical esophageal reconstruction[J]. Clin Plast Surg, 2005,32(3):339-346, vi. DOI: 10.1016/j.cps.2005.01.002. [10] Saeki H, Tsutsumi S, Yukaya T, et al.Clinicopathological features of cervical esophageal cancer: retrospective analysis of 63 consecutive patients who underwent surgical resection[J]. Ann Surg, 2017,265(1):130-136. DOI: 10.1097/SLA.0000000000001599. [11] Shuangba H, Jingwu S, Yinfeng W, et al.Complication following gastric pull-up reconstruction for advanced hypopharyngeal or cervical esophageal carcinoma: a 20-year review in a Chinese institute[J]. Am J Otolaryngol, 2011,32(4):275-278. DOI: 10.1016/j.amjoto.2010.05.002. [12] Dong DZ, Zhao D, Li S, et al.Nomogram to predict overall survival for patients with non-metastatic cervical esophageal cancer: a SEER-based population study[J]. Ann Transl Med, 2020,8(23):1588. DOI: 10.21037/atm-20-2505. [13] Cao CN, Luo JW, Gao L, et al.Definitive radiotherapy for cervical esophageal cancer[J]. Head Neck, 2015,37(2):151-155. DOI: 10.1002/hed.23572. [14] Mendenhall WM, Parsons JT, Vogel SB, et al.Carcinoma of the cervical esophagus treated with radiation therapy[J]. Laryngoscope, 1988,98(7):769-771. DOI: 10.1288/00005537-198807000-00017. [15] Stuschke M, Stahl M, Wilke H, et al.Induction chemotherapy followed by concurrent chemotherapy and high-dose radiotherapy for locally advanced squamous cell carcinoma of the cervical oesophagus[J]. Oncology, 1999,57(2):99-105. DOI: 10.1159/000012015. [16] Yamada K, Murakami M, Okamoto Y, et al.Treatment results of radiotherapy for carcinoma of the cervical esophagus[J]. Acta Oncol, 2006,45(8):1120-1125. DOI: 10.1080/02841860600609768. [17] Huang SH, Lockwood G, Brierley J, et al.Effect of concurrent high-dose cisplatin chemotherapy and conformal radiotherapy on cervical esophageal cancer survival[J]. Int J Radiat Oncol Biol Phys, 2008,71(3):735-740. DOI: 10.1016/j.ijrobp.2007.10.022. [18] Tong DK, Law S, Kwong DL, et al.Current management of cervical esophageal cancer[J]. World J Surg, 2011,35(3):600-607. DOI: 10.1007/s00268-010-0876-7. [19] Chen PN, Zhao XK, Zhou FY, et al.Characterization of 500 Chinese patients with cervical esophageal cancer by clinicopathological and treatment outcomes[J]. Cancer Biol Med, 2020,17(1):219-226. DOI: 10.20892/j.issn.2095-3941.2019.0268. [20] Takebayashi K, Tsubosa Y, Matsuda S, et al.Comparison of curative surgery and definitive chemoradiotherapy as initial treatment for patients with cervical esophageal cancer[J]. Dis Esophagus, 2017,30(2):1-5. DOI: 10.1111/dote.12502. [21] Kato K, Ito Y, Nozaki I, et al. Parallel-group controlled trial of surgery versus chemoradiotherapy in patients with stage I esophageal squamous cell carcinoma[J]. Gastroenterology, 2021,161(6):1878-1886.e2. DOI: 10.1053/j.gastro.2021.08.007.
2023, Vol. 32 
