Treatment and Prognosis of Resectable Cervical Esophageal Cancer: A Population-Based Study

BACKGROUND The optimal treatment strategy for resectable cervical esophageal cancer remains controversial. This study aimed to explore prognostic factors and optimal treatment strategies in the context of staging. METHODS In this population-based study, 1371 patients with resectable cervical esophageal cancer were identified in the Surveillance, Epidemiology, and End Results database. Univariate analysis and multivariable Cox regression model were performed to evaluate factors related to overall survival (OS). Subgroup analysis based on staging was performed to assess the effect of treatments on survival and propensity score matching was conducted to adjust confounding factors. RESULTS Univariate and multivariable analyses revealed that age, sex, year of diagnosis, histological type, tumor size, cN stage, surgery, radiotherapy, and chemotherapy are independent prognostic factors. After propensity score matching, patients with local disease (cT1-2N0M0) who received surgery alone had a higher 10-year OS rate than those received chemoradiotherapy (CRT) (20.7% vs 11.4%, P = .023). Compared with CRT, surgery-based multimodal therapy did not increase the OS rate of patients (14.8% vs 11.1%, P = .084). For regional disease (cT3-4aN0M0/cT1-4aN1-3M0), although surgery alone did not improve the OS rate of patients compared with CRT (7.3% vs 8.2%, P = .18), we observed a significant difference in 10-year OS among patients who underwent surgery-based multimodal therapy vs those who underwent CRT (20.4% vs 9.0%, P = .031). CONCLUSIONS Compared with CRT, surgery alone improves the long-term survival of patients with localized disease, and surgery-based multimodal therapy increases the survival rate of patients with regional disease. Further studies are required to confirm our findings. (C) 2022 by The Society of Thoracic Surgeons