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Background <p>The role of neoadjuvant chemotherapy (NAC) in clinical T2N0 (cT2N0) esophageal squamous cell carcinoma (ESCC) is controversial, largely due to limited evidence and the well-recognized inaccuracy in clinical staging.</p> Methods <p>We analyzed 263 patients with cT2N0 thoracic ESCC who underwent subtotal esophagectomy between 2000 and 2019. Patients were grouped into NAC plus surgery (n = 87) and upfront surgery (n = 176); 43 patients&#xa0;in the latter group received adjuvant chemotherapy based on pathological risk factors.</p> Results <p>Clinical staging accuracy was low, with only 15.3% of patients clinically diagnosed with T2N0 confirmed as pT2N0. Downstaging to pT1N0 occurred in 23.3% of patients, while 48.3% in the upfront surgery group showed occult pathological nodal metastasis (pN +). Lymphatic (37.2% vs. 64.2%, p &lt; 0.001) and vascular invasion rates were low in the NAC group (20.9% vs. 46.5%, p &lt; 0.001), but residual nodal disease remained common (32.2%). Median follow-up was 59&#xa0;months. Five-year overall survival (OS) and disease-free survival were comparable between NAC and upfront surgery groups (70.5% vs. 70.6%, p = 0.574; 67.8% vs. 65.8%, p = 0.817, respectively). Recurrence patterns were similar between groups. Among pN + patients in the upfront surgery cohort, adjuvant chemotherapy improved 5-year OS (72.1% vs. 58.7%, p = 0.033), with outcomes similar to pN0 patients.</p> Conclusion <p>Routine NAC did not improve long-term survival compared with upfront surgery in cT2N0 ESCC. Upfront surgery followed by selective postoperative adjuvant chemotherapy in patients with pathological nodal involvement was associated with survival outcomes approaching those of pN0 patients.</p>

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Neoadjuvant chemotherapy and surgery-based treatment with selective adjuvant chemotherapy for cT2N0 esophageal squamous cell carcinoma: a multicenter retrospective study

  • 期刊论文

  • 发表日期：

    2026年7月28日

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  • Tomohira Takeoka,
  • Hiroshi Miyata,
  • Koji Tanaka,
  • Shigeto Nakai,
  • Takahito Sugase,
  • Masaaki Yamamoto,
  • Takashi Kanemura,
  • Keijiro Sugimura,
  • Tomoki Makino,
  • Atsushi Takeno,
  • Osamu Shiraishi,
  • Masaaki Motoori,
  • Makoto Yamasaki,
  • Motohiro Hirao,
  • Kazumasa Fujitani,
  • Takushi Yasuda,
  • Masahiko Yano,
  • Yuichiro Doki

摘要

Background

The role of neoadjuvant chemotherapy (NAC) in clinical T2N0 (cT2N0) esophageal squamous cell carcinoma (ESCC) is controversial, largely due to limited evidence and the well-recognized inaccuracy in clinical staging.

Methods

We analyzed 263 patients with cT2N0 thoracic ESCC who underwent subtotal esophagectomy between 2000 and 2019. Patients were grouped into NAC plus surgery (n = 87) and upfront surgery (n = 176); 43 patients in the latter group received adjuvant chemotherapy based on pathological risk factors.

Results

Clinical staging accuracy was low, with only 15.3% of patients clinically diagnosed with T2N0 confirmed as pT2N0. Downstaging to pT1N0 occurred in 23.3% of patients, while 48.3% in the upfront surgery group showed occult pathological nodal metastasis (pN +). Lymphatic (37.2% vs. 64.2%, p < 0.001) and vascular invasion rates were low in the NAC group (20.9% vs. 46.5%, p < 0.001), but residual nodal disease remained common (32.2%). Median follow-up was 59 months. Five-year overall survival (OS) and disease-free survival were comparable between NAC and upfront surgery groups (70.5% vs. 70.6%, p = 0.574; 67.8% vs. 65.8%, p = 0.817, respectively). Recurrence patterns were similar between groups. Among pN + patients in the upfront surgery cohort, adjuvant chemotherapy improved 5-year OS (72.1% vs. 58.7%, p = 0.033), with outcomes similar to pN0 patients.

Conclusion

Routine NAC did not improve long-term survival compared with upfront surgery in cT2N0 ESCC. Upfront surgery followed by selective postoperative adjuvant chemotherapy in patients with pathological nodal involvement was associated with survival outcomes approaching those of pN0 patients.