Neoadjuvant chemoradiotherapy plus surgery versus surgery alone for clinical node‐negative esophageal carcinoma

Background The impact of neoadjuvant chemoradiotherapy (nCRT) on early stage esophageal cancer is unknown. Here, we compared the outcomes after esophagectomy alone or nCRT plus surgery for clinically staged node‐negative esophageal cancer. Methods We searched the Surveillance, Epidemiology, and End Results database for patients with clinically node‐negative (cN0) esophageal cancer from 2004 to 2016 who underwent surgery alone or nCRT plus surgery. Propensity score matching and Cox regression analysis were used to identify covariates associated with overall survival and cancer‐specific survival. Results A total of 1587 patients were retrospectively identified, of whom 49.8% (n = 791) received nCRT and 80.2% (n = 1273) were truly node‐negative diseases. For the entire cohort, surgery alone was associated with a statistically significant but modest absolute increase in survival outcomes (P
This study focuses on the use of neoadjuvant chemoradiotherapy to esophageal carcinoma patients with clinically staged node‐negative (cN0) status. Finally, compared with surgery alone, cN0 esophageal cancer with falsely node‐negative (pN+) or localized truly node‐negative (pT3‐4N0) gain a significant survival benefit from neoadjuvant chemoradiation. However, neoadjuvant chemoradiation plus surgery was associated with decreased survival for early‐staged true node‐negative (pT1‐2N0) patients. Despite the inherent limitations, this population‐based study allows for a robust analysis of patients with cN0 esophageal carcinoma and the benefits of neoadjuvant chemoradiation when stratified by nodal and tumor status, and this finding may have significant implications on the use of neoadjuvant chemoradiation in patients with cN0 disease.