Abstract
PURPOSE: This study aimed to examine the individualized neoadjuvant therapies for operable esophageal cancer. METHODS AND MATERIALS: Data of 95,444 patients diagnosed with esophageal cancer between 2010 and 2017 were collected from the Surveillance, Epidemiology, and End Results database. The effectiveness of neoadjuvant chemoradiotherapy (nCRT), neoadjuvant chemotherapy (nCT), and surgery alone was compared in patients with stage II esophageal cancer. Patients with stage III disease were divided into "local invasive type" group (type I, T3N1M0, T4N0-1M0) and "regional metastatic type" group (type II, T1-2N2-3M0) according to the tumor invasion pattern. The effectiveness of nCRT and nCT in different patterns was compared. RESULTS: In 2,706 patients with stage II disease, a statistical difference was observed in the overall survival (OS) between nCRT (85.1%), nCT (3.0%), and surgery alone (11.9%, P<0.001, median OS (mOS): 54 vs 41 vs 24 months). Meanwhile, 3,303 patients with stage III disease who received nCRT were included in the propensity score matching. A statistical difference was observed in the OS between "Type I" (n = 217) and "Type II" (n = 217, P = 0.023, mOS: 45 VS 28 months). Among 93 patients with stage III receiving nCT, those with "Type II" (23.7%) showed a greater potential benefit from nCT than those with "Type I" (76.3%, P = 0.686, mOS: 51 vs 40 months). CONCLUSIONS: nCRT is recommended for stage II esophageal cancer. In patients with stage III, those with "local invasive type" may greatly benefit from nCRT, while those with "regional metastatic type" may greatly benefit from nCT.