A pilot study of tegafur-uracil maintenance on survival in patients with esophageal squamous cell carcinoma following definitive chemoradiotherapy

Little was known regarding the maintenance role in patients with ESCC.This study evaluates the impact of Tegafur-Uracil (UFUR) maintenance on survival in patients with ESCC following definitive concurrent chemoradiotherapy (dCCRT). Patients with pathologically confirmed ESCC and treated with dCCRT were analyzed retrospectively. Patients were stratified into UFUR (+) and UFUR (-) groups based on maintenance or not after dCCRT. Oncologic outcomes, including progression-free survival (PFS), overall survival (OS), locoregional recurrence-free survival (LRFS), and distant metastasis-free survival (DMFS), were compared between the groups. Multivariate Cox regression analysis was performed to identify independent predictors of survival. A total of 198 ESCC patients were included into our study. UFUR maintenance significantly reduced the overall recurrence rate (55% vs. 74%, p = 0.009), primarily driven by a reduction in distant metastases (44% vs. 63%, p < 0.001). The UFUR (+) group demonstrated markedly improved median OS (37.3 vs. 18.6 months, p = 0.002) and PFS (28.3 vs. 15.2 months, p = 0.014). Superior LRFS and DMFS were observed in the UFUR (+) group than those in UFUR (-) group, accounting for 29.6 vs. 13.4 months (p = 0.002) and 33.3 vs. 19.0 months (p = 0.010), respectively. Subgroup analyses revealed that UFUR(+) provided consistent benefits across all stages and all dCCRT responses. Multivariate analysis identified UFUR maintenance as an independent predictor of survival, alongside tumor stage and response to dCCRT. UFUR maintenance significantly improves outcomes in patients with ESCC following dCCRT, which might be considered as part of personalized treatment strategies to optimize prognosis in ESCC.