Comparative analysis of long-term outcomes of surgical and combined treatment of patients with squamous cell carcinoma of the thoracic esophagus cT2N0M0

The OBJECTIVE was to improve immediate and long-term outcomes of surgical treatment by optimizing the choice of treatment strategy for patients with squamous cell carcinoma of the thoracic esophagus cT2N0M0.

METHODS AND MATERIALS. The analysis included 57 patients who underwent surgery for squamous cell carcinoma of the thoracic esophagus cT2N0M0 at the P. Hertsen Moscow Oncology Research Institute from 2005 to 2023. The upfront surgery group comprised 67 % (n=38) of the patients. Combined treatment was implemented in 19 (33 %) of the 57 patients. The accuracy of clinical staging of the tumor process was assessed, and a statistical analysis of risk factors for poor prognosis was performed. Overall and recurrence-free survival rates were evaluated using the Kaplan–Meier method.

RESULTS. Subgroup statistical analysis revealed that tumors ≤4 cm in length (n=33) on endoscopy were a prognostically favorable group, regardless of the presence or absence of preoperative treatment, with all patients reaching the 5-year overall survival mark. In the group with tumors >4 cm (n=24), true pT2N0M0 was found in only 44 %, with understaging – in 56 % and overstaging – in 0 %. Analysis of long-term outcomes revealed a median overall survival of 28 months in the combined treatment group versus 26 months in the up-front surgery group (p=0.87). The 3-year overall survival was 31 % versus 40 % (p=0.977), and the 5-year overall survival was 16.6 % versus 40 % (p=0.684) respectively.

CONCLUSION. Based on the study, it can be concluded that tumor length ≤4 cm is a favorable prognostic factor, and upfront surgery is preferable for such patients. In the group with tumors >4 cm, no statistically significant difference in long-term outcomes was found between the combined treatment and up-front surgery groups. However, in most cases, understaging occurs in this group, and such tumors should be interpreted as locally advanced processes, for which multimodal therapy is recommended according to current clinical guidelines.

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