br propensity matched patients treated with definitive


propensity-matched patients treated with definitive CRT and were 71.15%, 56.50%, and 46.17%, respectively, for propensity-matched patients treated with esophagectomy alone (p < 0.001). Multivariate analysis showed treatment strategy was an independent prognostic factor. Esoph-agectomy alone was associated with significantly better overall survival than definitive CRT for patients with clinical stage I/II disease. There was no survival risk dif-ference between definitive CRT and esophagectomy only for patients with clinical stage III disease.
Conclusions. Esophagectomy alone could provide bet-ter survival than definitive CRT for patients with clinical stage I/II esophageal SCC. However, definitive CRT and esophagectomy yield similar overall survival rates in clinical stage III patients.
We previously investigated the treatment modalities affecting survival of patients with esophageal cancer in Taiwan [3]. However, there were many selection biases and confounders in the study. Head-to-head comparative studies with matching pretreatment factors could have been per-formed to investigate the clinical effect of the different treatments.
Several studies have demonstrated the therapeutic ef-ficacy and protocol of definitive CRT [5–10]. A national cancer database reported only 17.1% of esophageal cancer patients underwent definitive radiotherapy with or without chemotherapy in Taiwan from 1998 to 2007 [1]. The percentage of patients undergoing definitive CRT rose to 43.2% during 2008 to 2012 [3]. Esophagectomy carries significant operative risks, and therefore, nonsur-gical management has become a favorable treatment method [8]. Esophagectomy, which could provide a curative remedy for esophageal cancer, Dorsomorphin a complex operation and carries moderate perioperative and
GENERAL
mortality risks [8]. The potential survival benefit of esophagectomy may be counterbalanced by its surgical risk compared with other nonsurgical treatments.
There are limited studies that have compared treat-ment outcomes between definitive CRT and esoph-agectomy alone [11–20]. These studies contained heterogeneous clinical stages, limited numbers of pa-tients, and unbalanced pretreatment factors, which explain the insignificant results. Large clinical studies that directly compare the two treatments are lacking.
The purpose of cytosine study was to investigate the treat-ment outcomes between definitive CRT and esoph-agectomy alone. We used the Taiwan Cancer Registry to analyze the survival of esophageal SCC patients treated with definitive CRT or esophagectomy alone. We also performed propensity-matched analysis to reduce study bias. Overall survival was compared between patients grouped according to clinical stage I, II, or III and treat-ment with definitive CRT or esophagectomy alone.
Patients and Methods
The Changhua Christian Hospital Internal Review Board approved the study. Informed consent was waived owing to the retrospective study design. Patient information was obtained from the Taiwan Cancer Registry, a database [21] implemented in 1979 and updated annually by the Ministry of Health and Welfare of Taiwan. The Taiwan Cancer Registry currently collects long-form data, including cancer stage at diagnosis and the first course of treatment. The completeness (97%) and data quality of the cancer registry database is at an excellent level. Under governmental commission, novice training courses and supports to registrars have been standardized, and field data audits are performed periodically through medical record reviews to ensure data accuracy. Quality of life, date of return to work, length of stay, complications, and comorbidities are not reported in the database. Data from the Taiwan Cancer Registry is not risk adjusted. Therefore, we used the Charlson Comorbidity Index score for risk adjustment. The National Health Insurance Research Database was used to collect Charlson scores.