Impact of adjuvant therapy on survival in esophageal cancer patients after neoadjuvant therapy investigated by a population based cohort study

While surgical intervention administered after neoadjuvant therapy represents the standard treatment in esophageal cancer, the survival benefit conferred by adjuvant therapy administered postoperatively among this patient cohort continues to be controversial. Using real-world data, 6141 esophageal cancer patients administered neoadjuvant treatment preoperatively between 2007 and 2021 were categorized into adjuvant therapy group (n = 1116) or no adjuvant therapy group(n = 5025). No significant differences in overall survival (OS) or cancer-specific survival (CSS) were observed between groups before or after propensity score matching (PSM), and adjuvant therapy was not identified as an independent prognostic factor. However, subgroup analyses revealed important variations: patients treated in 2015-2021 derived greater survival benefit from adjuvant therapy than those in 2007-2014; female patients experienced worse CSS with adjuvant therapy, which was identified as an independent risk factor; among patients receiving preoperative systemic therapy alone, continuing systemic therapy postoperatively showed superior outcomes compared with radiotherapy or combined treatment; and among patients receiving preoperative chemoradiotherapy, no significant differences were observed across different postoperative adjuvant strategies. The findings suggest that while postoperative adjuvant therapy does not provide an overall survival advantage, significant subgroup heterogeneity exists, indicating that clinical decisions should be individualized based on diagnosis year, gender, and preoperative treatment regimen.