Dataset Information

Efficacy of adjuvant chemotherapy on overall survival in patients with lymph node-positive esophageal squamous cell carcinoma: Is oral chemotherapy promising?

ABSTRACT:

Background

The role of adjuvant chemotherapy in patients with pathological lymph node-positive (pN+) resectable esophageal squamous cell carcinoma (ESCC) remains unclear. We aimed to explore whether adjuvant chemotherapy could improve the overall survival (OS) of patients with pN+ ESCC and whether oral chemotherapy could be used as an alternative to intravenous chemotherapy.

Methods

The patients were divided into two groups: a surgery plus chemotherapy group (S + CT group, 400 patients) and a surgery alone group (S group, 582 patients). Propensity score matching (PSM) was used to create patient groups that were balanced across several covariates (n = 331 in each group). The survival rates of patients receiving oral chemotherapy (69 patients with S-1 and 68 patients with tegafur tablets) and intravenous chemotherapy (263 patients) were compared using the Kaplan-Meier method.

Results

In the overall study cohort, the 3-year OS was significantly higher in the S + CT group than in the S group (66.3% vs. 49.9%, p < 0.001). These data were confirmed in the matched groups (3-year OS, 72.9% vs. 62.0%, p < 0.001). Multivariate Cox regression analysis in the matched samples showed that adjuvant chemotherapy was an independent prognostic factor for ESCC (HR: 0.62, 95% CI: 0.50-0.76, p < 0.001). Patients who received oral chemotherapy had a similar OS as patients who received intravenous chemotherapy.

Conclusions

Adjuvant chemotherapy could significantly improve the OS of patients with pN+ ESCC, and oral chemotherapy drugs might be a better option because of their similar efficacy but fewer side effects than intravenous chemotherapy. This conclusion warrants further study in prospective, randomized controlled trials.

SUBMITTER: Fang S

PROVIDER: S-EPMC9972109 | biostudies-literature | 2023 Feb

REPOSITORIES: biostudies-literature

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Publications

Efficacy of adjuvant chemotherapy on overall survival in patients with lymph node-positive esophageal squamous cell carcinoma: Is oral chemotherapy promising?

Fang Shuogui S Zhong Jian J Mai Zihang Z Li Tong T Xie Xiuying X Fu Jianhua J

Cancer medicine 20220922 4

<h4>Background</h4>The role of adjuvant chemotherapy in patients with pathological lymph node-positive (pN+) resectable esophageal squamous cell carcinoma (ESCC) remains unclear. We aimed to explore whether adjuvant chemotherapy could improve the overall survival (OS) of patients with pN+ ESCC and whether oral chemotherapy could be used as an alternative to intravenous chemotherapy.<h4>Methods</h4>The patients were divided into two groups: a surgery plus chemotherapy group (S + CT group, 400 pat ...[more]

PMID: 36134648

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Project description:Background: The rates of locoregional and distant recurrence for esophageal squamous cell carcinoma (ESCC) patients underwent radical esophagectomy remain high. The purpose of this study is to explore an optimal postoperative therapeutic modality by investigating the efficacy of various adjuvant therapies in the treatment of ESCC. Methods: We retrospectively reviewed 408 ESCC patients underwent thoracic esophagectomy and 3-field lymph node dissection from 2010 to 2015. Patients were classified into surgery alone (Group S), adjuvant chemotherapy (Group CT) and postoperative chemotherapy plus radiotherapy (Group CRT), respectively. Univariate and multivariate Cox regression analyses were used to analyze prognostic factors and survival. Results: The overall survival (OS) and disease-free survival (DFS) were similar among groups. Postoperative CT and CRT both were beneficial for patients with positive lymph nodes, particularly for those with 3 or more lymph nodes involvement and metastasis in the middle thoracic segment compared with surgery alone. The 3-year OS and DFS for patients with 3 or more lymph nodes involvement were 30.8%, 53.7%, 50.5% and 19.9%, 41.6%, 34.0% for Group S, CT, and CRT, respectively (p=0.04; p=0.004, respectively). There was no notable difference in OS and DFS between the adjuvant Group CT and CRT (p=0.42; p=0.49, respectively). Postoperative CRT significantly reduced the rates of distant metastasis and overall recurrence for patients with positive lymph nodes (p=0.042; p=0.01, respectively). Number of metastatic lymph nodes, extent of resection, and AJCC stage were independent predictors of survival. Grade 1-2 myelosuppression was experienced significantly more frequently by patients in Group CRT than those in Group CT (P=0.03). Late toxicities were rare and manageable overall. Conclusions: Postoperative CT and CRT both were associated with better survival for patients with positive lymph nodes, particularly for those with 3 or more lymph nodes involvement and metastasis in the middle thoracic segment. Postoperative CRT was significantly more effective at reducing the rates of distant metastasis and overall recurrence for patients with positive lymph nodes.

Project description:ImportanceBreast cancer treatment can impact not only short-term health but may also affect longer-term quality of life (QOL).ObjectiveTo describe and evaluate factors associated with diminished QOL following completion of active treatment.Design, setting, and participantsThis was a secondary analysis of a randomized clinical trial included patients with lymph node-positive or high-risk lymph node-negative breast cancer who had undergone definitive surgery and were enrolled in ECOG-ACRIN E5103, a multisite phase 3 trial. A survey was administered 18 months after enrollment to patients enrolled between January and June 2010. Final analysis of the data took place from March to December 2021.InterventionsPatients received adjuvant doxorubicin, cyclophosphamide, and paclitaxel with either bevacizumab or placebo.Main outcomes and measuresQOL and health status assessed with the EuroQol 5-Dimension 3-Levels (EQ-5D-3L), EQ-visual analog scale (EQ-VAS), and the Functional Assessment of Cancer Therapy-Breast Cancer, with arm subscale (FACT-B+4). Groups were compared by Fisher exact test, Wilcoxon rank sum, or Kruskal-Wallis test. Multivariable linear regression was used to assess factors independently associated with FACT-B scores.ResultsData at 18 months were available from 455 of 519 patients (87.7%) enrolled in the trial. Median (range) age at enrollment was 52 (25-76) years. No differences in QOL (median [range] FACT-B scores: group A, 123 [67-146]; group B, 114 [54-148]; group C, 117 [42-148]; P = .23) or health status (median [range] EQ-5D-3L index scores: group A, 0.83 [0.28-1.00]; group B, 0.83 [0.20-1.00]; group C, 0.83 [0.17-1.00], P = .80; median EQ-VAS: group A, 85 [20-100]; group B, 85 [0-100]; group C, 85 [0-100]; P = .79) were observed across treatment groups; results for subsequent analyses were therefore reported irrespective of primary treatment. Overall, half of patients (258 of 444 [58%]) reported at least some pain or discomfort; 170 (38%) reported symptoms of anxiety or depression. In multivariable analyses, mastectomy with radiation (vs breast conserving surgery) and Asian, Black, or American Indian or Alaska Native race (vs White race) were associated with lower QOL (mastectomy with radiation: coefficient: -5.5; 95% CI, -10.1 to -0.9; Asian, Black, or American Indian or Alaska Native race: coefficient: -7.3; 95% CI, -13.2, -1.4).Conclusions and relevanceIn this study, the addition of bevacizumab to chemotherapy was not negatively associated with QOL at 18 months. A substantial proportion of participants reported problems related to pain or discomfort and anxiety or depression, demonstrating persistent consequences for physical and psychosocial well-being in this heavily treated population. Many problems reported are amenable to intervention, underscoring the need for timely referral to supportive resources, especially for women of color and those who have more extensive local therapy.Trial registrationClinicalTrials.gov Identifier: NCT00433511.

Dataset Information

Efficacy of adjuvant chemotherapy on overall survival in patients with lymph node-positive esophageal squamous cell carcinoma: Is oral chemotherapy promising?

Background

Methods

Results

Conclusions

Publications

Efficacy of adjuvant chemotherapy on overall survival in patients with lymph node-positive esophageal squamous cell carcinoma: Is oral chemotherapy promising?

Similar Datasets

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