Analysis of the efficacy of radical surgery versus radiotherapy in T1-2N0M0 proximal esophageal squamous cell carcinoma
XIAO Liang
ZHANG Huan
ZHANG Bowen
WANG Yichun
YE Dongmei
Abstract：Objective To compare the efficacy differences between radical surgery and definitive radiotherapy in the treatment of stage T1-2N0M0 proximal esophageal squamous cell carcinoma,and to provide evidence for clinical treatment selection.Methods General data of patients with proximal esophageal squamous cell carcinoma admitted to the First Affiliated Hospital of Anhui Medical University from January 2013 to December 2022 were retrospectively collected.Patients with stage T1-2N0M0 who received definitive radiotherapy or radical surgery were selected.Propensity score matching(PSM)was applied to balance baseline differences between groups.Survival curves were plotted using the Kaplan-Meier method to compare overall survival(OS)between the two groups.Cox proportional hazards regression model was used to analyze factors related to prognosis.Results A total of 128 patients were included,with 79 in the surgery group and 49 in the radiotherapy group.There were no statistically significant differences in 3-year survival rate(80.93％vs.79.57％),5-year survival rate(64.37％vs.71.37％),or 10-year survival rate(24.41％vs.58.56％)between the radiotherapy and surgery groups(P＞0.05).After PSM,32 patients were included in each group,and the difference in OS between the two groups remained statistically insignificant(P＞0.05).Univariate Cox regression analysis showed that only age was a risk factor affecting OS(P=0.037),while gender,lesion location,smoking history,drinking history,lesion length,comorbidities,and treatment modality were not associated with OS(P＞0.05).Further multivariate Cox regression analysis,including clinically potentially significant variables(age,lesion location,length,comorbidities,and treatment modality),revealed that age(HR=2.865,95％CI:1.398-5.871,P=0.004)and lesion length(HR=2.105,95％CI:1.062-4.174,P=0.033)were independent prognostic factors for OS.Subgroup analysis showed that for patients with lesion length＞2.5 cm,the surgery group had better OS than the radiotherapy group(P=0.045).Recurrence occurred in 31 patients,with 19 in the surgery group and 12 in the radiotherapy group,and there was no statistically significant difference in recurrence rates between the two groups(P＞0.05).Conclusion Definitive radiotherapy and surgery have comparable efficacy in the treatment of stage T1-2N0M0 proximal esophageal carcinoma.Patients with lesion length＞2.5 cm may achieve better outcomes with surgery than with radiotherapy.Further studies are needed to better define the optimal patient populations for different treatment strategies.
Keywords：esophageal cancerproximalearly stageradiotherapyesophagectomy
Publication Date：2026-02-28
Online Publishing Date：2026-04-01(First online date of this platform, not the publication date of the document)
Pages：6( 198-203 )