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Published on: December 27, 2024
Neoadjuvant chemotherapy and surgery-based treatment with selective adjuvant chemotherapy for cT2N0 esophageal
Tomohira Takeoka1,2, Hiroshi Miyata3, Koji Tanaka4
1Department of Gastroenterological Surgery, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-ku, Osaka, Japan.
Background:
The role of neoadjuvant chemotherapy (NAC) in clinical T2N0 (cT2N0) esophageal squamous cell carcinoma (ESCC) is controversial, largely due to limited evidence and the well-recognized inaccuracy in clinical staging.
Methods:
We analyzed 263 patients with cT2N0 thoracic ESCC who underwent subtotal esophagectomy between 2000 and 2019. Patients were grouped into NAC plus surgery (n = 87) and upfront surgery (n = 176); 43 patients in the latter group received adjuvant chemotherapy based on pathological risk factors.
Results:
Clinical staging accuracy was low, with only 15.3% of patients clinically diagnosed with T2N0 confirmed as pT2N0. Downstaging to pT1N0 occurred in 23.3% of patients, while 48.3% in the upfront surgery group showed occult pathological nodal metastasis (pN +). Lymphatic (37.2% vs. 64.2%, p < 0.001) and vascular invasion rates were low in the NAC group (20.9% vs. 46.5%, p < 0.001), but residual nodal disease remained common (32.2%). Median follow-up was 59 months. Five-year overall survival (OS) and disease-free survival were comparable between NAC and upfront surgery groups (70.5% vs. 70.6%, p = 0.574; 67.8% vs. 65.8%, p = 0.817, respectively). Recurrence patterns were similar between groups. Among pN + patients in the upfront surgery cohort, adjuvant chemotherapy improved 5-year OS (72.1% vs. 58.7%, p = 0.033), with outcomes similar to pN0 patients.
Conclusion:
Routine NAC did not improve long-term survival compared with upfront surgery in cT2N0 ESCC. Upfront surgery followed by selective postoperative adjuvant chemotherapy in patients with pathological nodal involvement was associated with survival outcomes approaching those of pN0 patients.
