Multimodality treatment for esophageal adenocarcinoma: multi-center propensity-score matched study

Abstract

BackgroundThe primary aim of this study was to compare survival from neoadjuvant chemoradiotherapy plus surgery (NCRS) versus neoadjuvant chemotherapy plus surgery (NCS) for the treatment of esophageal or junctional adenocarcinoma. The secondary aims were to compare pathological effects, short-term mortality and morbidity, and to evaluate the effect of lymph node harvest upon survival in both treatment groups.MethodsData were collected from 10 European centers from 2001 to 2012. Six hundred and eight patients with stage II or III oesophageal or oesophago-gastric junctional adenocarcinoma were included; 301 in the NCRS group and 307 in the NCS group. Propensity score matching and Cox regression analyses were used to compensate for differences in baseline characteristics.ResultsNCRS resulted in significant pathological benefits with more ypT0 (26.7% versus 5%; P < 0.001), more ypN0 (63.3% versus 32.1%; P < 0.001), and reduced R1/2 resection margins (7.7% versus 21.8%; P < 0.001). Analysis of short-term outcomes showed no statistically significant differences in 30-day or 90-day mortality, but increased incidence of anastomotic leak (23.1% versus 6.8%; P < 0.001) in NCRS patients.There were no statistically significant differences between the groups in 3-year overall survival (57.9% versus 53.4%; Hazard Ratio (HR)= 0.89, 95%C.I. 0.67-1.17, P = 0.391) nor disease-free survival (52.9% versus 48.9%; HR = 0.90, 95%C.I. 0.69-1.18, P = 0.443). The pattern of recurrence was also similar (P = 0.660). There was a higher lymph node harvest in the NCS group (27 versus 14; P < 0.001), which was significantly associated with a lower recurrence rate and improved disease free survival within the NCS group.ConclusionThe survival differences between NCRS and NCS maybe modest, if present at all, for the treatment of locally advanced esophageal or junctional adenocarcinoma. Future large-scale randomized trials must control and monitor indicators of the quality of surgery, as the extent of lymphadenectomy appears to influence prognosis in patients treated with NCS, from this large multi-center European study.

Neoadjuvant chemoradiotherapy followed by minimally invasive esophagectomy: is it a superior approach for locally advanced resectable esophageal squamous cell carcinoma?

“…RM approach was a safe option for locally advanced ESCC, which was consistent with the conclusion from previous studies mainly focusing on esophageal adenocarcinoma. Previous studies have found that nCRT improved pathological complete response (pCR) rate and reduced lymph node metastases rate when compared to nCT (21,(23)(24)(25). The latest NeoRes trial (26) also confirmed the outcomes in ESCC subgroups.…”

A retrospective study of pattern of recurrence after radical surgery for thoracic esophageal carcinoma with or without postoperative radiotherapy

“…Multimodality treatment has become increasingly used for EC, which proved to have good outcomes (5). Neoadjuvant chemoradiotherapy was proved to be a better strategy for local advanced patients (6,7).…”

Immunonutrition before esophagectomy: Impact on immune surveillance mechanisms

“…1 In a recent, large European cohort of stage II and III esophago-gastric junction and esophageal adenocarcinoma, the 3-year overall survival rate was 55% and a 3-year disease-free survival was 50% after multimodal therapy. 27 Thus, after definitive treatment of esophageal cancer, patients are still at high risk for recurrence. A recent, large American study reported that recurrence occurred more frequently in the first year after surgery and they were distant in 55% of cases, locoregional in 28%, or both in 17%.…”