Radiat Oncol. 2026 Jul 15. doi: 10.1186/s13014-026-02886-x. Online ahead of print.
ABSTRACT
BACKGROUND AND PURPOSE: The optimal postoperative adjuvant treatment for pathological T3N0M0 (pT3N0M0) thoracic esophageal squamous cell carcinoma (TESCC) remains unclear. This study evaluated whether adding radiotherapy to postoperative chemotherapy provides an additional survival benefit in these patients.
METHODS: We retrospectively reviewed 1,090 TESCC patients treated at Sichuan Cancer Hospital (2009-2020). After applying inclusion and exclusion criteria, 356 patients who received adjuvant therapy were analyzed: 274 underwent surgery plus postoperative chemotherapy (S+POCT) and 82 received surgery plus postoperative chemoradiotherapy (S+POCRT). Propensity score matching balanced baseline characteristics between groups. Overall survival (OS) and disease-free survival (DFS) were compared, and survival predictors were assessed using a Cox proportional hazards model.
RESULTS: Before matching, the S+POCRT group had more female patients, and patients with vascular or perineural invasion were more likely to receive chemoradiotherapy. After matching (82 patients per group), baseline characteristics were balanced. The 5-year OS was 70.9% for the entire cohort. In the matched cohort, 5-year OS rates were 65.3% (S+POCT) versus 71.4% (S+POCRT), and 5-year DFS rates were 63.3% versus 70.9%, respectively. No statistically significant differences in OS or DFS were observed between the two groups. Multivariate analysis indicated that neither postoperative chemotherapy nor chemoradiotherapy independently improved OS. In the subgroup analysis, patients with tumors located in the lower third of the esophagus were more likely to derive a significant DFS benefit from S+POCRT but no subgroup showed a statistically significant OS benefit from S+POCRT compared with S+POCT.
CONCLUSIONS: For pT3N0M0 TESCC patients undergoing R0 resection without neoadjuvant therapy, postoperative chemotherapy alone provides comparable survival to chemoradiotherapy in the overall retrospective cohort. These findings suggest that the routine addition of postoperative radiotherapy to chemotherapy may not provide a clear survival advantage in the overall pT3N0M0 TESCC population. Further prospective studies are needed to identify patients who may benefit from postoperative radiotherapy.
CLINICAL TRIAL NUMBER: Not applicable.
PMID:42458490 | DOI:10.1186/s13014-026-02886-x
