Neoadjuvant therapy reduces the incidence of nodal micrometastases in esophageal adenocarcinoma

Wang, Da; Smit, Jw; Zwaan, Eva; Muijs, Christina T.; Groen, Henk; Hollema, Harry; Plukker, John

doi:10.1016/j.amjsurg.2013.03.004

Cited by 12 publications

(9 citation statements)

References 29 publications

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“…However, the incidence rates of MM with or without MI and MI alone in the nCRT group were significantly lower than those in the Surgery group, indicating that patients presenting MM with or without MI and MI alone might benefit from nCRT. These results are consistent with the retrospective study of Wang et al, in which significant reduction of LNM was obtained after nCRT in node-negative esophageal adenocarcinoma patients (17). Whether LNM progresses to overt metastasis or regresses spontaneously due to immune system activity cannot be determined.…”

Section: Discussionsupporting

confidence: 92%

Effect of Neoadjuvant Chemoradiotherapy on Lymph Node Micrometastases in Thoracic Esophageal Cancer

Yanagi

Sasaki

Uchikado

et al. 2018

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Section: Discussionsupporting

confidence: 92%

Effect of Neoadjuvant Chemoradiotherapy on Lymph Node Micrometastases in Thoracic Esophageal Cancer

Yanagi

Sasaki

Uchikado

et al. 2018

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“…Nevertheless, receipt of postoperative chemotherapy did not impact the observed outcome differences between PC and CRT in our study. While there may be benefits of PC that include tumor down staging (23,24), earlier treatment of micrometastases (25,26), and appraisal of tumor response to chemotherapy (8), these benefits are arguably more beneficial to patients with CN-positive disease. Delaying definitive surgery, for PC delivery, among the CN-negative patient may explain some of the survival differences observed among CN-negative patients.…”

Section: Discussionmentioning

confidence: 99%

Comparison of perioperative chemotherapy with adjuvant chemoradiotherapy for resectable gastric cancer: findings from a population-based study

Jabo

Selleck

Morgan³

et al. 2018

J. Gastrointest. Oncol.

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Background: Both perioperative chemotherapy (PC) and adjuvant chemoradiotherapy (CRT) improve survival in resectable gastric cancer; however, these treatments have never been formally compared. Our objective was to evaluate treatment trends and compare survival outcomes for gastric cancer patients treated with surgery and either PC or CRT.Methods: We performed a retrospective population-based cohort study between 2007 through 2013 using California Cancer Registry data. Patients diagnosed with stage IB-III gastric adenocarcinoma and treated with total or partial gastrectomy were eligible for this study. Based on the type of treatment received, patients were grouped into surgery-only, PC, or CRT. Primary and secondary outcomes were overall survival (OS) and gastric cancer-specific survival (GCCS) respectively. Mortality hazards ratios (HRs) for each of these outcomes were computed using propensity score weighted and covariate-adjusted Cox regression models, stratified by clinical node status.Results: Of 2,146 patients who underwent surgical resection, 1,067 had surgery-only, while 771 and 308 received PC or CRT, respectively. Median OS was 25, 33, and 52 months for surgery-only, PC, and CRT, respectively; P<0.001. Overall, patients treated with PC had significantly poorer survival compared to CRT (HR =1.45; 95% CI: 1.22-1.73). PC was also associated with higher mortality in patients with signet ring histology (HR =1.66; 95% CI: 1.21-2.28) and clinical node negative cancer (HR =1.85; 95% CI: 1.32-2.60). Survival was not different between PC vs. CRT in clinical node positive patients (HR =1.29; 95% CI: 0.84-2.08). Of note, the percentage of patients receiving PC increased from 17.5% in 2007-2008, to 41.5% in 2013-2014; P<0.001. Conclusions: Despite the rapid adoption of PC, overall, CRT is associated with better survival than PC.Specifically, clinical node negative and signet ring histology patients had better survival when treated with CRT compared to PC. Based on these findings, we recommend against indiscriminate adoption of PC and consideration for CRT over PC in clinical node negative patients.

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“…The most important hypothesis supporting such genuine survival benefit of an extended lymphadenectomy is the clearance of micrometastases that can be present in up to 50% of histology-negative nodes and are associated with a poor outcome. 27 Some authors question any therapeutic impact of extended lymphadenectomy. 16,[24][25][26] In the present data, within the nCRT + surgery group, no such prognostic impact of the number of resected nodes could be identified, let alone any therapeutic impact on survival.…”

Section: Therapeutic Considerationsmentioning

confidence: 99%

Lymph Node Retrieval During Esophagectomy With and Without Neoadjuvant Chemoradiotherapy

Talsma¹,

Shapiro²,

et al. 2014

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Neoadjuvant therapy reduces the incidence of nodal micrometastases in esophageal adenocarcinoma

Cited by 12 publications

References 29 publications

Effect of Neoadjuvant Chemoradiotherapy on Lymph Node Micrometastases in Thoracic Esophageal Cancer

Effect of Neoadjuvant Chemoradiotherapy on Lymph Node Micrometastases in Thoracic Esophageal Cancer

Comparison of perioperative chemotherapy with adjuvant chemoradiotherapy for resectable gastric cancer: findings from a population-based study

Lymph Node Retrieval During Esophagectomy With and Without Neoadjuvant Chemoradiotherapy

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