Quantifying the Survival Benefit of Trimodality Therapy in Esophageal Squamous Cell Carcinoma: An IPTW-adjusted Retrospective Analysis

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Dilli İ., Kavak E. E., sütcüoğlu o., İSAK Ö. A., EREN G. K., imamoğlu g. i., ...Daha Fazla

Acta haematologica oncologica Turcica, cilt.59, sa.2, ss.112-119, 2026 (Scopus, TRDizin)

Özet

Aim: The survival advantage of surgery following chemoradiotherapy in esophageal squamous cell carcinoma (ESCC) remains debated due to potential selection bias in non-randomized studies. We aimed to quantify the magnitude of survival benefit associated with trimodality therapy after rigorous adjustment for baseline imbalances. Methods: We retrospectively analyzed 54 patients with stage II-III ESCC treated between 2022 and 2025. Patients received either neoadjuvant chemoradiotherapy followed by surgery (trimodality group, n=24) or definitive chemoradiotherapy alone (dCRT group, n=30). To address treatment selection bias, inverse probability of treatment weighting (IPTW) based on propensity scores was applied. Progression-free survival (PFS) and overall survival (OS) were evaluated using weighted Kaplan-Meier estimates and Cox proportional hazards models. Results: At a median follow-up of 23.5 months, trimodality therapy was associated with a substantially prolonged PFS compared with dCRT (median 67.6 vs. 9.2 months, p=0.007). Similarly, OS was significantly improved (median 72.1 vs. 16.6 months, p=0.009). In multivariable analysis, surgery remained independently associated with improved OS [hazard ratio (HR): 0.41, 95% confidence interval (CI): 0.22-0.78, p=0.006] and PFS (HR: 0.44, 95% CI: 0.24-0.81, p=0.008). These findings were consistent after IPTW adjustment (OS HR: 0.46; PFS HR: 0.49, both p<0.01), indicating a robust and clinically meaningful survival benefit. Conclusion: After rigorous adjustment for baseline differences, trimodality therapy was associated with a substantial survival advantage over dCRT in patients with locally advanced ESCC. These findings suggest that the magnitude of benefit with surgery may be greater than previously appreciated in real-world populations, supporting its use in appropriately selected patients.