Survival analysis of additional radiotherapy after endoscopic therapy in patients with T1N0M0 esophageal cancer

This study aims to investigate prognostic factors in patients with T1N0M0 esophageal cancer (EC) treated with endoscopic therapy (ET) and evaluate the impact of additional radiotherapy (RT) after ET. Data of patients with T1N0M0 EC undergoing ET were extracted from the Surveillance, Epidemiology, and End Results database (2004-2016). Patients were divided into ET and ET + RT groups. Propensity score matching was applied, and survival outcomes were assessed using Kaplan-Meier and Cox regression analyses, with subgroup analyses by T stage. After propensity score matching, 394 patients were included. Compared with ET alone, additional RT was associated with significantly worse overall survival and cancer-specific survival. Age, T stage, and RT were identified as independent prognostic factors. Subgroup analysis indicated that T1a patients did not benefit from RT, while T1b patients showed a slight trend toward improvement, but without statistical significance. Additional RT after ET does not improve survival in T1N0M0 EC, particularly in T1a patients, and may even be detrimental. These findings highlight the importance of individualized treatment and suggest that ET alone remains sufficient for most early-stage cases.