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  • MK0683 br GENERAL THORACIC br results suggest esophagectomy alone could


    results suggest esophagectomy alone could provide better survival than definitive CRT in clinical stage I and II pa-tients. Regarding clinical stage III, no significant difference in overall survival was found between the two groups.
    Definitive CRT is recommended as one of the main treatments by National Comprehensive Cancer Network guidelines [4]. The Radiation Therapy Oncology Group (RTOG) 85-01/Intergroup (INT) 123 clinical trials have demonstrated the therapeutic efficacy of definitive CRT [5, 6]. Mikhail and colleagues [9] reviewed 12 trials to study the survival of esophageal cancer patients who had undergone definitive CRT. The distribution of 2-year overall survival rates ranged from 18% to 54% among the 12 trials. The variation of the survival rates among studies could be the results of different study designs and patient selections. To date, using large data to report the survival effectiveness of definitive CRT for esophageal cancer is still not enough. The treatment outcome of definitive CRT should be well investigated.
    Chemoradiotherapy for Oesophageal Cancer Followed by Surgery Study (CROSS) trials [7] and other systemic 
    reviews [24] have showed the treatment efficacy of neo-adjuvant CRT followed by esophagectomy. In contrast, the
    French Francophone de Cancerologie Digestive (FFCD) 9901 trials [25] indicated contradictory results. We previ-ously investigated treatment modalities that affect survival of patients with esophageal cancer [3], although many se-lection biases existed in the study. In this MK0683 study, we used propensity score matching to directly MK0683 compare definitive CRT with esophagectomy alone in esophageal SCC using the Taiwan Cancer Registry. Future studies should consider making head-to-head comparisons between different treatment strategies, including neoadjuvant CRT followed by esophagectomy.
    Two randomized controlled trials [11–12] found no statistically significant difference between the definitive CRT group and esophagectomy alone. No strong con-clusions can be drawn due to the small sample sizes and highly selective patient criteria. A meta-analysis compared survival, locoregional control, and treatment-related mortality between definitive CRT and esophagectomy alone. This meta-analysis indicated
    THORACIC  1066 WANG ET AL Ann Thorac Surg
    GENERAL  overall survival was equivalent between esoph-agectomy and definitive CRT [14].
    Several retrospective cohort studies have directly compared survival rates of patients with esophageal cancer who underwent definitive CRT and esoph-agectomy alone [15–20]. The evidence overall suggests Initiation factors there are no differences in survival rates between definitive CRT and esophagectomy alone [15–19]. How-ever, these comparative studies have limited patient numbers, heterogeneous clinical stages, and varying prognostic factors [15–20]. Therefore, the findings from these studies are tentative.
    We used the Taiwan Cancer Registry to investigate the survival difference between definitive CRT and esoph-agectomy alone. In the unmatched data, we found that esophagectomy alone was associated with better overall survival than definitive CRT, regardless of clinical stage. Lin and colleagues [26] also analyzed trimodality therapy and definitive CRT based on the Taiwan Cancer Registry. They indicated definitive CRT was a poor independent prognostic factor in the multivariate analysis. They did not perform propensity score matching to balance the pretreatment clinical variables among different treatment groups. For example, patients referred for definitive CRT may not be surgical candidates because of medical comorbidities. Patients with fewer or less severe comor-bidities tended to undergo esophagectomy.
    We attempted to reduce the bias and used the Charlson score in the propensity score matching framework. In the clinical stage III unmatched patients, we found that esophagectomy alone was associated with better overall survival than definitive CRT. After we balanced the pre-treatment clinical variables, including the Charlson score, the survival rate was similar between definitive CRT and esophagectomy alone.