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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
AbstractObjective 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.
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.
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2023, Vol. 32 
