İsmail DİLLİ, Engin Eren KAVAK, Osman SÜTÇÜOĞLU, Özlem Aydın İSAK, Gizem KAVAK, Gökşen İnanç İMAMOĞLU, Doğan YAZILITAŞ, Bülent AKSEL, Ferit AYDIN, Abdullah ŞENLİKÇİ, Mustafa Taner BOSTANCI, Semra Demirtaş ŞENLİK, Şehnaz EVRİMLER, Ata Türker ARIKÖK, Yıldız GÜNEY, Güler YAVAŞ, Dılşa Mızrak KAYA
Acta Haematologica Oncologica Turcica - 2026;59(2):112-119
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.
