Surgery or radiotherapy, which is more effective for upper esophageal carcinoma? A retrospective cohort study based on 191 cases

Background: to compare radical surgery with definitive radiotherapy for upper third esophageal squamous cell carcinoma. materials and methods: a total of 191 patients were included in the study. patients’ clinicopathologic features, and survival time were recorded. kaplan-meier (k-m) analysis was adopted to analyze overall survival (os), disease-free survival(dfs), progression-free survival(pfs), and a cox multivariate model was used to adjust potential confound factors. results: the k-m survival analysis showed that treatments, location of lesion, and length of lesion were all associated with the os (p<0.005). in the surgery group, k-m survival showed that t stage (t1 vs t2, p=0.012, t1 vs t3, p=0.002), location (upper vs upper merged middle, p<0.001), and length lesion (<5 cm vs >5 cm, p=0.015), affected the os，t stage (t1 vs t2, p=0.018, t1 vs t3, p=0.020) and location of lesion (upper vs upper merged middle, p=0.007) was associated with dfs. the cox model showed that none of these parameters independently influenced the os and dfs. in the radiotherapy group, k-m survival showed that supraclavicular lymph node metastasis (p=0.007), concurrent chemoradiotherapy (p=0.012), and sex (p=0.047) influenced the os，adjuvant chemotherapy (p=0.013) and age (p=0.013) influenced pfs, the cox model showed that supraclavicular lymph node metastasis (p=0.018) independently influenced os and adjuvant chemotherapy (p=0.046) independently influenced pfs. conclusion: surgery has better therapeutic effect than radiotherapy. patients with an upper merged middle lesion and advanced t stage for surgery, male, local advanced and without concurrent chemoradiotherapy for radiotherapy have a poor prognosis.