Evidence map›Paper›PMID 40090462›Full record

ArticleThe Journal of thoracic and cardiovascular surgery2025

Association of chemoradiation, trimodality therapy, or salvage resection with survival in stage II-III esophageal squamous cell carcinoma.

Sara Sakowitz, Syed Shahyan Bakhtiyar, Saad Mallick, Yas Sanaiha, Ann Raldow, Peyman Benharash, Jane Yanagawa

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Article in The Journal of thoracic and cardiovascular surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed.

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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

7 authors.

Sara SakowitzCORELAB, Department of Surgery, University of California, Los Angeles, Los Angeles, Calif; Department of Surgery, Massachusetts General Hospital, Boston, Mass.
Syed Shahyan BakhtiyarCORELAB, Department of Surgery, University of California, Los Angeles, Los Angeles, Calif; Department of Surgery, University of Colorado, Aurora, Colo.
Saad MallickCORELAB, Department of Surgery, University of California, Los Angeles, Los Angeles, Calif; Department of Surgery, University of California, Los Angeles, Los Angeles, Calif.
Yas SanaihaCORELAB, Department of Surgery, University of California, Los Angeles, Los Angeles, Calif; Division of Thoracic Surgery, Department of Surgery, University of California, Los Angeles, Los Angeles, Calif.
Ann RaldowDepartment of Radiation Oncology, University of California, Los Angeles, Los Angeles, Calif.
Peyman BenharashCORELAB, Department of Surgery, University of California, Los Angeles, Los Angeles, Calif; Department of Surgery, University of California, Los Angeles, Los Angeles, Calif.
Jane YanagawaCORELAB, Department of Surgery, University of California, Los Angeles, Los Angeles, Calif; Division of Thoracic Surgery, Department of Surgery, University of California, Los Angeles, Los Angeles, Calif. Electronic address: JYanagawa@mednet.ucla.edu.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveEsophageal squamous cell carcinoma remains highly lethal and often undertreated. With conflicting evidence regarding the additional benefit of surgical resection to chemoradiation, many patients with locoregionally advanced disease may receive chemoradiation and then undergo evaluation for progression before esophagectomy. We hypothesized that trimodality therapy or salvage resection would be linked with superior overall survival, relative to definitive chemoradiation.

methodsThis retrospective analysis of the 2004-2021 National Cancer Database identified all patients aged 18 years or more with clinically staged II-III esophageal squamous cell carcinoma. Patients undergoing chemotherapy with 41.4 Gy or more of radiation across 28 fractions, followed by esophagectomy at less than 90 days, were considered the trimodality cohort, and those undergoing resection at 90 days or more were classified as salvage. Patients receiving definitive chemoradiation were categorized as definitive chemoradiotherapy.

resultsOf 3786 patients, 912 (24%) underwent trimodality therapy, 173 (5%) received chemoradiation followed by salvage resection, and 2701 (71%) received definitive chemoradiotherapy. After risk adjustment and relative to definitive chemoradiotherapy, trimodality was linked with greater survival at 1 year (hazard ratio [HR], 0.45, CI, 0.34-0.59) and 5 years (HR, 0.57, CI, 0.49-0.66), as was salvage (1 year: HR, 0.38, CI, 0.22-0.69; 5 years: HR, 0.54, CI, 0.40-0.73). On restricted mean survival time analysis, trimodality demonstrated a 9.17-month (CI, 6.40-11.94) incremental increase in overall survival time over 5 years, whereas salvage was linked with a 10.03-month (CI, 4.04-16.03) increase in survival time compared with definitive chemoradiotherapy.

conclusionsSurgical resection after chemoradiation confers a survival benefit and should be considered a mainstay in the management of locoregionally advanced esophageal squamous cell carcinoma. Yet, with comparable outcomes across trimodality and salvage approaches, organ preservation may be appropriate for select patients.

Indexed as

ChemoradiotherapyEsophageal NeoplasmsEsophageal Squamous Cell CarcinomaEsophagectomySalvage TherapyAgedDatabases, FactualFemaleHumansMaleMiddle AgedNeoplasm StagingRetrospective StudiesTime FactorsTreatment Outcomechemoradiationesophageal canceresophageal squamous cell carcinomaesophagectomysalvage esophagectomysurvivaltrimodality therapy

Identifiers

PMID40090462

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.