[Comparison of efficacy among different treatment strategies for cervical esophageal squamous cell carcinoma​]

Objective: To compare the efficacy of different treatment strategies for cervical esophageal squamous cell carcinoma (CESCC) using inverse probability of treatment weighting (IPTW), and to explore the prognostic factors of CESCC. Methods: We retrospectively analyzed the clinical data of 307 patients with T1-4N0-3M0 stage CESCC admitted to Qilu Hospital of Shandong University from 2005 to 2019. There were 264 males and 43 females, aged from 39 to 84 years. The patients were divided into 4 groups: surgery alone (SA) group (n=46), definitive concurrent chemoradiotherapy (DCRT) group (n=123), postoperative concurrent chemoradiotherapy (S-CRT) group (n=99), and neoadjuvant chemoradiotherapy followed by surgery (NCRT-S) group (n=39). IPTW was used to balance baseline characteristics and to adjust for confounding factors. Survival analysis was performed, with overall survival (OS) and disease-specific survival (DSS) as primary endpoints. Results: After IPTW adjustment, baseline characteristics including age and gender were well balanced (all P>0.05). Log-rank test revealed statistically significant differences in OS and DSS survival curves among the 4 groups before and after IPTW (all P<0.05). After IPTW, the median OS of the SA, DCRT, S-CRT, and NCRT-S groups were 78, 58, 92, and 86 months, with 5-year OS rates of 50.9%, 48.0%, 56.5% and 52.5%, respectively. The median DSS was 78, 60, 110, and 96 months, with 5-year DSS rates of 52.0%, 49.0%, 59.3% and 55.8%, respectively. Multivariate Cox regression analysis showed that drinking history (HR=1.324, 95%CI: 1.117-2.446), lymph node metastasis (HR=1.317, 95%CI: 1.199-1.929) and concomitant hypopharyngeal involvement (HR=0.574, 95%CI: 0.355-0.926) were independent prognostic factors for CESCC (all P<0.05). Conclusion: Significant differences exist in long-term survival among the four treatment strategies for CESCC. Surgery-based multimodal therapy (S-CRT/NCRT-S) shows a more favorable survival trend numerically. Stratified intensive treatment and frequent follow-up are recommended for patients with drinking history and lymph node metastasis.