Neoadjuvant therapy followed by surgery is recommended for locally advanced esophageal cancer. With the inaccuracies of clinical staging particularly for cT1N+ and cT2Nany tumors, some have proposed consideration of surgery followed by adjuvant treatment. | Huang et al. BMC Cancer 2021 21 1334 https s12885-021-08896-0 RESEARCH ARTICLE Open Access The ideal approach for treatment of cT1N and cT2Nany esophageal cancer. a NCDB analysis Binhao Huang1 2 3 4 Ernest G. Chan4 Arjun Pennathur4 James D. Luketich4 and Jie Zhang1 4 Abstract Background Neoadjuvant therapy followed by surgery is recommended for locally advanced esophageal cancer. With the inaccuracies of clinical staging particularly for cT1N and cT2Nany tumors some have proposed consideration of surgery followed by adjuvant treatment. Our objective is to evaluate the efficacy of neoadjuvant therapy vs surgery followed by adjuvant therapy and to identify the ideal sequence of treatment in patients with cT1N and cT2Nany tumors. Methods We performed an analysis utilizing the National Cancer Database 2006-2015 identifying all patients with cT1N and cT2Nany esophageal cancer undergoing esophagectomy. The treatment was stratified as neoadjuvant therapy NT adjuvant therapy AT and combination therapy of neoadjuvant and adjuvant CT groups and outcomes were analyzed. Results We identified 2795 patients with n 2289 receiving NT n 285 AT and n 221 CT. There were no significant differences noted in survival among AT NT and CT group in cT1N P cT2N- P cT2N P esophageal cancer by multivariate analysis using Cox regression model. This relationship held true in both squamous cell carcinoma and adenocarcinoma. Conclusion In clinical T1N T2Nany patients there was no evident superiority of NT over AT. Surgery followed by adjuvant therapy can be considered to be an alternative option in these patients. Further prospective studies are needed to validate these findings. Keywords Esophageal cancer Neoadjuvant therapy Adjuvant therapy National Cancer Database Analysis of Esophageal Cancer Correspondence pennathura@ zhangjie2289@ Presented at the Southern Thoracic Surgical Association s 66th Annual Meeting Marco Island .
