Surgery versus chemoradiotherapy in patients with stage T1bN0M0 esophageal cancer: a retrospective cohort study

To compare survival outcomes between surgery and chemoradiotherapy in patients with stage T1bN0M0 esophageal cancer. Stage T1bN0M0 esophageal cancer patients treated with either surgery or chemoradiotherapy were extracted from the Surveillance, Epidemiology, and End Results database between 2000 and 2020. Included patients were divided into two groups: surgery and chemoradiotherapy. Cancer-specific survival (CSS) and overall survival (OS) were compared between the two groups. Among the 515 patients included in the study, 55 (10.7%) underwent chemoradiotherapy and 460 (89.3%) received surgery. Surgery showed better 5-year CSS (73.2% vs. 31.0%; hazard ratio [HR] = 0.27, 95% confidence interval [CI] 0.19-0.39; P < 0.001) and OS (60.0% vs. 21.5%; HR = 0.35, 95% CI 0.25-0.48; P < 0.001) compared to chemoradiotherapy. Subgroup analysis indicated that surgery remained associated with superior 5-year CSS (61.3% vs. 40.6%; HR = 0.51, 95% CI 0.26-0.99; P = 0.049) and OS (48.9% vs. 23.8%; HR = 0.52, 95% CI 0.29-0.91; P = 0.021) compared to chemoradiotherapy in squamous cell carcinoma patients. Similarly, surgery showed better 5-year CSS (76.0% vs. 27.1%; HR = 0.22, 95% CI 0.14-0.34; P < 0.001) and OS (62.7% vs. 20.6%; HR = 0.31, 95% CI 0.21-0.46; P < 0.001) compared to chemoradiotherapy in adenocarcinoma patients. Surgery is associated with superior survival outcomes compared to chemoradiotherapy in stage T1bN0M0 esophageal cancer and should be considered the preferred treatment for eligible patients, particularly in settings where consistent follow-up and salvage therapy may be limited.