Abstract
BACKGROUND: This large retrospective study aimed to compare the long-term survival outcomes of esophageal squamous cell carcinoma (ESCC) patients with stage T4N0-3M0 treated with surgery followed by adjuvant chemoradiotherapy (S+CRT) versus definitive chemoradiotherapy (dCRT). METHODS: Patients with T4N0-3M0 ESCC who received S+CRT or dCRT at our institution between January 2011 and December 2018 were included in the study. RESULTS: A total of 490 patients with stage T4N0-3M0 ESCC met the enrollment criteria, with 108 in the S+CRT group and 382 in the dCRT group. Overall survival (OS) and progression-free survival (PFS) were significantly better in S+CRT group compared to the dCRT group (P = 0.000, 0.003). After propensity score matching (PSM) analysis, 138 patients in the dCRT group and 81 patients in the S+CRT group were successfully matched. OS and PFS were again significantly better in the S+CRT group compared to the dCRT group (P = 0.002, 0.019). CONCLUSIONS: S+CRT is more likely to improve the overall prognosis of patients with T4N0-3M0 ESCC compared to dCRT. Treatment plan should be made based on a thorough consideration of both the patient's condition and tumor characteristics, leading to individualized decisions.