ArticleTherapeutic advances in gastroenterology2026
Additional chemoradiotherapy versus esophagectomy for early esophageal cancer: an integrated analysis of reconstructed time-to-event data.
Article in Therapeutic advances in gastroenterology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Management of early-stage esophageal squamous cell carcinoma (ESCC) following non-curative endoscopic resection remains controversial, particularly for patients with pathological risk factors like deep submucosal invasion (pT1b) or lymphovascular invasion (LVI). While surgery is the standard for ensuring oncological clearance, it carries significant morbidity. Additional chemoradiotherapy (CRT) offers an organ-preserving alternative, yet previous meta-analyses have failed to clarify its efficacy in specific high-risk subgroups. Objectives: This study aimed to compare the long-term survival of additional CRT versus esophagectomy using reconstructed time-to-event data. Design: Systematic review and meta-analysis. Data Sources and Methods: A systematic review of major databases was conducted from inception to September 2025. Comparative studies evaluating additional CRT versus surgery post-endoscopic resection were included. Individual patient data were reconstructed from published Kaplan-Meier curves to estimate hazard ratios (HRs). Primary outcomes were recurrence-free survival (RFS) and overall survival (OS). Stratified analyses evaluated the modifying effects of pT1b depth and LVI. Results: Seven retrospective studies comprising 616 patients were included. Quantitative synthesis revealed no significant difference between CRT and surgery in RFS (HR = 1.020, 95% CI 0.856-1.214) or OS (HR = 1.031, 95% CI 0.886-1.200). Crucially, subgroup analyses demonstrated that this therapeutic equivalence was robust and not significantly modified by the proportion of pT1b invasion, tumor location, or LVI status. Conclusion: Additional CRT provides long-term survival outcomes comparable to radical esophagectomy for non-curative ESCC, even in high-risk subgroups defined by deep submucosal invasion or LVI. CRT should be considered a potential, organ-preserving alternative to surgery in selected patients. Trial registration: INPLASY2025110080.
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