BACKGROUND Although both neoadjuvant chemoradiotherapy (nCRT) and chemotherapy (nCT) are used as neoadjuvant treatment for oesophageal cancer, it is unknown whether one provides a survival advantage over the other, particularly with respect to histological subtype. This study aimed to compare prognosis after nCRT and nCT in patients undergoing oesophagectomy for oesophageal adenocarcinoma (OAC) or squamous cell carcinoma (OSCC). METHODS Data from the National Cancer Database (2006-2015) were used to identify patients with OAC and OSCC. Propensity score matching and Cox multivariable analyses were used to account for treatment selection biases. RESULTS The study included 11 167 patients with OAC (nCRT 9972, 89.3 per cent; nCT 1195, 10.7 per cent) and 2367 with OSCC (nCRT 2155, 91.0 per cent; nCT 212, 9.0 per cent). In the matched OAC cohort, nCRT provided higher rates of complete pathological response (35.1 versus 21.0 per cent; P < 0.001) and margin-negative resections (90.1 versus 85.9 per cent; P < 0.001). However, patients who had nCRT had similar survival to those who received nCT (hazard ratio (HR) 1.04, 95 per cent c.i. 0.95 to 1.14). Five-year survival rates for patients who had nCRT and nCT were 36 and 37 per cent respectively (P = 0.123). For OSCC, nCRT had higher rates of complete pathological response (50.9 versus 30.4 per cent; P < 0.001) and margin-negative resections (92.8 versus 82.4 per cent; P < 0.001). A statistically significant overall survival benefit was evident for nCRT (HR 0.78, 0.62 to 0.97). Five-year survival rates for patients who had nCRT and nCT were 45.0 and 38.0 per cent respectively (P = 0.026). CONCLUSION Despite pathological benefits, including primary tumour response to nCRT, there was no prognostic benefit of nCRT compared with nCT for OAC suggesting that these two modalities are equally acceptable. However, for OSCC, nCRT followed by surgery appears to remain the optimal treatment approach.

中文翻译：

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新辅助放化疗或仅用于食管癌的化疗：基于人群的队列研究。

背景技术尽管新辅助放化疗（nCRT）和化学治疗（nCT）均被用作食道癌的新辅助治疗，但尚不清楚一个能否提供生存优势，特别是在组织学亚型方面。这项研究的目的是比较接受食管腺癌（OAC）或鳞状细胞癌（OSCC）的食管切除术的nCRT和nCT患者的预后。方法使用来自美国国家癌症数据库（2006-2015）的数据来鉴定患有OAC和OSCC的患者。倾向得分匹配和Cox多变量分析用于说明治疗选择偏倚。结果该研究包括11 167例OAC患者（nCRT 9972，占89.3％； nCT 1195，10.7％）和2367例OSCC（nCRT 2155，91.0％； nCT 212，9.0％）。在相符的OAC群组中，nCRT提供更高的完全病理反应率（35.1比21.0％； P <0.001）和切缘阴性切除术（90.1比85.9％； P <0.001）。但是，接受nCRT的患者的生存率与接受nCT的患者相似（危险比（HR）1.04，95％ci为0.95至1.14）。患有nCRT和nCT的患者的五年生存率分别为36％和37％（P = 0.123）。对于OSCC，nCRT的完全病理反应率更高（50.9％对30.4％； P <0.001）和切缘阴性切除术（92.8％对82.4％； P <0.001）。nCRT的总体生存获益具有统计学意义（HR 0.78，0.62至0.97）。患有nCRT和nCT的患者的五年生存率分别为45.0％和38.0％（P = 0.026）。结论尽管有病理学益处，包括对nCRT的原发肿瘤反应，与nCT相比，nCRT对于OAC没有预后的益处，这表明这两种方式同样可以接受。然而，对于OSCC，nCRT继之以外科手术似乎仍然是最佳的治疗方法。