The role of adjuvant platinum‐based chemotherapy in esophagogastric cancer patients who received neoadjuvant chemotherapy prior to definitive surgery

Saunders, J.; Bowman, C R; Reece-Smith, Alex; Pang, Vincent; Dorrington, M S; Mumtaz, Errum; Soomro, Irshad; Kaye, Philip; Madhusudan, Srinivasan; Parsons, Simon L.

doi:10.1002/jso.24601

Cited by 30 publications

(22 citation statements)

References 20 publications

(45 reference statements)

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“…In keeping with this, a recent study14 found no survival benefit for adjuvant platinum‐based chemotherapy in patients who were non‐responders in the neoadjuvant setting. Prospective trials are required to determine any benefit of changing or tailoring chemotherapy regimens in non‐responding patients.…”

Section: Discussionmentioning

confidence: 82%

Patterns of recurrence in oesophageal cancer following oesophagectomy in the era of neoadjuvant chemotherapy

Knight

Zylstra²,

Hemelrijck

et al. 2017

BJS Open

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BackgroundTumour recurrence following oesophagectomy for oesophageal cancer is common despite neoadjuvant treatment. Understanding patterns of recurrence and risk factors associated with locoregional and systemic recurrence might influence future treatment strategies.MethodsThis was a cohort study involving patients undergoing resection for adenocarcinoma or squamous cell carcinoma of the oesophagus between 2000 and 2014. Clinicopathological factors associated with locoregional and systemic recurrence were analysed using multivariable logistic regression to determine odds ratios (ORs) and 95 per cent confidence intervals.ResultsSome 698 patients were identified. Lymphovascular invasion (OR 2·09, 95 per cent c.i. 1·18 to 3·71) and preoperative stenting (OR 3·70, 1·34 to 10·23) were independent risk factors for isolated locoregional recurrence. Pathological nodal disease in patients with pT1–2 (pN1: OR 2·72, 1·35 to 5·48; pN2–3: OR 5·00, 2·35 to 10·66) or pT3–4 (pN1: OR 3·03, 1·51 to 6·07; pN2–3: OR 5·75, 3·15 to 10·49) disease predisposed to systemic recurrence. Poor or no response to chemotherapy was also an independent risk factor for isolated systemic recurrence (OR 1·85, 1·05 to 3·26). A positive resection margin (R1 resection) was not associated with a significantly increased risk of isolated locoregional recurrence (OR 1·37, 0·81 to 2·33).ConclusionThese findings confirm that oesophageal adenocarcinoma is frequently a systemic disease. Understanding the key predictors of local and systemic recurrence may facilitate the tailoring of oncological therapies to the individual patient.

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Section: Discussionmentioning

confidence: 82%

Patterns of recurrence in oesophageal cancer following oesophagectomy in the era of neoadjuvant chemotherapy

Knight

Zylstra²,

Hemelrijck

et al. 2017

BJS Open

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“…Infectious complications after oesophagogastric surgery have been reported to produce a proinflammatory cytokine (interleukins 6 and 8)‐mediated response, which may also promote tumour progression after oesophagectomy. Second, the prolonged period needed to recover from this severe illness frequently precludes adjuvant chemotherapy, which has been shown to confer a significant survival benefit in responders to neoadjuvant chemotherapy.…”

Section: Discussionmentioning

confidence: 99%

Impact of postoperative complications on disease recurrence and long-term survival following oesophagogastric cancer resection

Saunders

Yanni

Dorrington

et al. 2019

British Journal of Surgery

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Background: Postoperative complications after resection of oesophagogastric carcinoma can result in considerable early morbidity and mortality. However, the long-term effects on survival are less clear. Methods: All patients undergoing intentionally curative resection for oesophageal or gastric cancer between 2006 and 2016 were selected from an institutional database. Patients were categorized by complication severity according to the Clavien-Dindo classification (grades 0-V). Complications were defined according to an international consensus statement. The effect of leak and severe non-leak-related complications on overall survival, recurrence and disease-free survival was assessed using Kaplan-Meier analyses to evaluate differences between groups. All factors significantly associated with survival in univariable analysis were entered into a Cox multivariable regression model with stepwise elimination. Results: Some 1100 patients were included, with a median age of 69 (range 28-92) years; 48⋅1 per cent had stage III disease and cancer recurred in 428 patients (38⋅9 per cent). Complications of grade III or higher occurred in 244 patients (22⋅2 per cent). The most common complications were pulmonary (29⋅9 per cent), with a 13⋅0 per cent incidence of pneumonia. Rates of atrial dysrhythmia and anastomotic leak were 10⋅0 and 9⋅6 per cent respectively. Patients with a grade III-IV leak did not have significantly reduced overall survival compared with those who had grade 0-I complications. However, patients with grade III-IV non-leak-related complications had reduced median overall survival (19⋅7 versus 42⋅7 months; P < 0⋅001) and disease-free survival (18⋅4 versus 36⋅4 months; P < 0⋅001). Cox regression analysis identified age, tumour stage, resection margin and grade III-IV non-leak-related complications as independent predictors of poor overall and disease-free survival. Conclusion: Beyond the acute postoperative period, anastomotic leak does not adversely affect survival, however, other severe postoperative complications do reduce long-term overall and disease-free survival. Statistical analysisContinuous variables are described as median (i.q.r. or range) or mean(s.d.), and were compared using the Mann-Whitney U test and Student's t test respectively. The χ 2 test was used for analysis of discrete data. OS was

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“…The selection of patients for more individualized treatment could be further improved with refinements in the definition of chemotherapy responders. This may avoid the unnecessary treatment of non-responders with adjuvant chemotherapy that may cause significant morbidity for no survival benefit 28,30 . The present results suggest that the categories for defining a response should be regression scores of 1-3 (fibrosis over 50 per cent in either the primary tumour or lymph node), although this should be examined in more detail in a large validation cohort.…”

Section: Discussionmentioning

confidence: 99%

Lymph node regression and survival following neoadjuvant chemotherapy in oesophageal adenocarcinoma

Davies

Myoteri²,

Zylstra

et al. 2018

British Journal of Surgery

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The role of adjuvant platinum‐based chemotherapy in esophagogastric cancer patients who received neoadjuvant chemotherapy prior to definitive surgery

Cited by 30 publications

References 20 publications

Patterns of recurrence in oesophageal cancer following oesophagectomy in the era of neoadjuvant chemotherapy

Patterns of recurrence in oesophageal cancer following oesophagectomy in the era of neoadjuvant chemotherapy

Impact of postoperative complications on disease recurrence and long-term survival following oesophagogastric cancer resection

Lymph node regression and survival following neoadjuvant chemotherapy in oesophageal adenocarcinoma

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