Clinical outcomes and appropriate treatment strategies of locally advanced resectable cervical esophageal cancer.

313 Background: Due to its rare nature, no standard treatment based on the randomized controlled trials for locally-advanced resectable cervical esophageal cancer (rCEC) has been established. Prognostic factors of locally-advanced rCEC are not also well evaluated. When considering the treatment for rCEC, larynx preservation (LP) is an important issue, as well as the prolongation of survival. This study aimed to clarify the clinical outcomes and prognostic factors on locally-advanced rCEC, and the appropriate treatment strategies focused on both LP and long-term survival. Methods: We retrospectively reviewed the medical records of rCEC patients treated with surgery or definitive chemoradiotherapy (CRT) at our institute from 2010 to 2020. This retrospective study was approved by the institutional review board of NCCH (2017-229). Results: A total of 123 cases were extracted as subjects, treated with surgery in 53 and CRT in 70. 1/3/5-year PFS and OS in all subjects were 52/40/36% and 84/60/56%, respectively. Univariate analysis indicated that clinical tumor depth might be a prognostic factor (T1 vs. T≥2, hazard ratio [HR]: 2.30, p=0027. in PFS; HR: 2.86, p=0.046 in OS). In the subjects with ≥T3 lesion (N=95) who usually require laryngectomy, both PFS (31.0 vs. 7.0 months, HR: 0.50, p=0.013) and OS (not reached vs. 25.0 months, HR: 0.28, p=0.005) were better in subjects treated with surgical approach than with CRT. Focused on the cases with ≥T3 lesion and initially treated with induction chemotherapy (N=33), the surgical approach also showed better clinical outcomes than the CRT approach (median PFS: 19.0 vs. 8.0 months, HR: 0.37, p=0.007; median OS: not reached vs. 18.0 months, HR: 0.18, p=0.007). Especially, subjects treated with induction chemotherapy followed by larynx-preserving surgery achieved better outcomes. Conclusions: This study indicated that clinical depth might be a significant prognostic factor in rCEC. A chemo-selection approach using induction chemotherapy might be a good strategy to achieve LP and improve survival outcomes in locally-advanced rCEC.