现有的临床试验倾向于对局部晚期食管癌（EC）进行新辅助放化疗（NCRT），然后单独进行手术，并将围手术期化疗作为食管腺癌（EAC）的首选治疗方式。然而，尚不清楚这些试验结果是否反映在临床环境中患者的护理模式和生存结果中。旨在调查不同治疗方式后 EC 患者在临床环境中的生存结果。这项回顾性队列研究检查了以下数据：由美国外科医生学会维护的国家癌症数据库，重点关注临床 II 期或 III 期 EC 患者，不包括接受三联治疗（NCRT 随后食管切除术）、根治性放化疗 (DCRT)、放射治疗的胃食管交界癌患者。单独放疗，或2006年1月至2020年12月围手术期化疗。分析时间为2023年12月至2024年8月。围手术期化疗、三联治疗、DCRT和单模放疗。采用Cox比例风险回归模型比较总生存期整个队列中治疗组之间、鳞状细胞癌或腺癌患者以及 65 岁以上患者的总生存期 (OS)。在 6 个月时进行了标志性生存分析，以减少生存偏差。该研究纳入了 57116 名患者（中位年龄 64 [IQR，57-72] 岁；45410 名 [79.5%] 男性）； 21619 名患者（37.9%）接受了三联治疗，32493 名患者（57.1%）接受了 DCRT，2692 名患者（4.7%）接受了单一治疗，312 名患者（0.5%）接受了围手术期化疗。在整个研究人群中，37698 名患者 (66.0%) 患有 EAC，而在接受围手术期化疗的 312 名患者中，283 名 (90.7%) 患有 EAC。在调整生存分析中，围手术期化疗（调整风险比 [AHR]，0.33；95% CI，0.28-0.39；P <.001）和三联疗法（AHR，0.45；95% CI，0.44-0.46；P < .001） ）与 DCRT 相比 OS 改善相关。相反，与 DCRT 相比，单独放疗的结果更差（AHR，1.37；95% CI，1.30-1.45；P < .001）。围手术期化疗的中位 OS 为 66.2 个月（95% CI，43.1-111.9 个月；P < .001），比单纯 DCRT 的中位 OS 更长（18.1 个月；95% CI，17.8-18.4 个月；P < .001） 。三联疗法的中位 OS 为 43.9 个月（95% CI，42.8-45.5 个月；P < .001），比围手术期化疗短，但比单独 DCRT 和 RT 有所改善，后者与中位 OS 相关。 OS 为 13.5 个月（95% CI，12.8-14.0 个月；P < .001）。在年龄超过 65 岁的患者亚组中，与接受其他治疗方式（例如三联疗法）的患者相比，接受围手术期化疗的患者中位 OS 更长（56.7 个月；95% CI，36.4-115.2 个月；P<0.001）： 40.1 个月；95% CI，38.1-42.0 个月；P < .001）。单独接受放疗的患者中位 OS 最差（13.6 个月；95% CI，12.8-14.4 个月；P< .001）。在这项针对 II 期至 III 期 EC 患者的队列研究中，三联治疗与 OS 改善相关。单独使用 DCRT 或 RT 治疗局部晚期 EC 和围手术期化疗与腺癌 OS 的改善相关。

Existing clinical trials favor neoadjuvant chemoradiation therapy (NCRT) followed by surgery alone for locally advanced esophageal cancer (EC) and perioperative chemotherapy as the preferred modality for esophageal adenocarcinoma (EAC). However, it is unclear whether these trial findings are reflected in the patterns of care and survival outcomes among patients in the clinical setting.To investigate survival outcomes in the clinical setting among patients with EC after various treatment modalities.This retrospective cohort study examined data from the National Cancer Database maintained by the American College of Surgeons and focused on patients with clinical stage II or III EC, excluding those with gastroesophageal junction cancer, who underwent trimodality therapy (NCRT followed by esophagectomy), definitive chemoradiation therapy (DCRT), radiotherapy (RT) alone, or perioperative chemotherapy from January 2006 to December 2020. Analyses were conducted from December 2023 to August 2024.Perioperative chemotherapy, trimodality therapy, DCRT, and single-modality RT.A Cox proportional hazards regression model was used to compare overall survival (OS) between treatment groups in the entire cohort, among patients with squamous cell carcinoma or adenocarcinoma, and among those older than 65 years. Landmark survival analysis at 6 months was performed to reduce survivorship bias.The study included 57 116 patients (median age, 64 [IQR, 57-72] years; 45 410 [79.5%] male); 21 619 patients (37.9%) received trimodality therapy, 32 493 (57.1%) received DCRT, 2692 (4.7%) received single-modality RT, and 312 (0.5%) received perioperative chemotherapy. In the overall study population, 37 698 patients (66.0%) had EAC, and of the 312 patients that received perioperative chemotherapy, 283 (90.7%) had EAC. In adjusted survival analysis, perioperative chemotherapy (adjusted hazard ratio [AHR], 0.33; 95% CI, 0.28-0.39; P <.001) and trimodality therapy (AHR, 0.45; 95% CI, 0.44-0.46; P < .001) were associated with improved OS compared with DCRT. In contrast, RT alone was associated with worse outcomes compared with DCRT (AHR, 1.37; 95% CI, 1.30-1.45; P < .001). The median OS for perioperative chemotherapy of 66.2 months (95% CI, 43.1-111.9 months; P < .001) was longer compared with that for DCRT alone (18.1 months; 95% CI, 17.8-18.4 months; P < .001). Trimodality therapy was associated with a median OS of 43.9 months (95% CI, 42.8-45.5 months; P < .001), which was shorter than that for perioperative chemotherapy but improved compared with DCRT and RT alone, which was associated with a median OS of 13.5 months (95% CI, 12.8-14.0 months; P < .001). In the subgroup of patients older than 65 years, those who received perioperative chemotherapy had longer median OS (56.7 months; 95% CI, 36.4-115.2 months; P < .001) compared with those receiving other treatment modalities (eg, trimodality therapy: 40.1 months; 95% CI, 38.1-42.0 months; P < .001). Patients who received RT alone had the worst median OS (13.6 months; 95% CI, 12.8-14.4 months; P < .001).In this cohort study of patients with stage II to III EC, trimodality therapy was associated with improved OS compared with DCRT or RT alone for locally advanced EC and perioperative chemotherapy was associated with improved OS for adenocarcinoma.