The Role of Continuing Perioperative Chemotherapy Post Surgery in Patients with Esophageal or Gastroesophageal Junction Adenocarcinoma: a Multicenter Cohort Study

Papaxoinis, George; Kamposioras, Konstantinos; Weaver, Jamie; Kordatou, Zoe; Stamatopoulou, Sofia; Germetaki, Theodora; Nasralla, Magdy; Owen-Holt, Vikki; Anthoney, Alan; Mansoor, Wasat

doi:10.1007/s11605-018-04087-8

Cited by 8 publications

(10 citation statements)

References 35 publications

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“…Similar to the current analysis, at least two studies from European centers found no significant difference in survival between patients who received postoperative chemotherapy after preoperative chemotherapy and resection and those who did not. 16,23 However, other studies have reported improved survival with postoperative chemotherapy. In a single-institution study from the United Kingdom, Mirza et al 24 found that completion of neoadjuvant and adjuvant therapy was independently associated with improved survival.…”

Section: Discussionmentioning

confidence: 99%

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Analysis of the Survival Impact of Postoperative Chemotherapy After Preoperative Chemotherapy and Resection for Gastric Cancer

et al. 2020

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Background. Perioperative chemotherapy is a standardof-care treatment for patients with gastric cancer. However, the impact of the postoperative chemotherapy (postCTX) component on overall survival (OS) is not well defined. Methods. The National Cancer Database (NCDB) 2006-2014 was queried for patients who received preoperative chemotherapy (preCTX) and resection for gastric cancer. Analysis was performed to identify factors influencing receipt of postCTX. The impact of postCTX on OS was evaluated in propensity-matched groups. Results. Among 3449 patients who received preCTX and resection for gastric cancer, 1091 (31.6%) received postCTX. Independent predictors of receiving postCTX were diagnosis after 2010 (odds ratio [OR] 1.985), distal tumor location (OR 1.348), and 15 or more lymph nodes examined (OR 1.214). Predictors of not receiving postCTX were older age (OR 0.985), comorbidity score higher than 1 (OR 0.592), and black race (OR 0.791). After propensitymatching (1091 per group), the median OS was 56.8 months for those who did receive postCTX versus 52.5 months for those who did not (p = 0.131). Subset analysis according to tumor grade, lymphovascular invasion, number of lymph nodes evaluated, T and N class, and AJCC stage identified an improvement in OS for the patients with N1 disease who received postCTX compared with those who did not (79.6 vs 41.3 months; p = 0.025). However, no other subgroup had a significant survival benefit. Conclusions. Additional postCTX was administered to a minority of patients who received preCTX and gastrectomy for gastric cancer, and its influence on OS appeared to be limited. Future trials should aim to define patients who will benefit from postCTX. For patients with locoregional gastric cancer, multimodality therapy offers better progression-free survival (PFS) and overall survival (OS) than surgery alone. 1,2 For patients with disease classified as cT2 or higher, the current National Comprehensive Cancer Network (NCCN) guidelines recommend perioperative chemotherapy as the preferred management strategy. 3 Improved oncologic outcomes using this approach were first recognized with publication of the MAGIC trial in 2006. 4 In that study, patients were randomized to receive three cycles of epirubicin, cisplatin, and fluorouracil (ECF) followed by surgery and then three additional cycles of chemotherapy Electronic supplementary material The online version of this article (

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Analysis of the Survival Impact of Postoperative Chemotherapy After Preoperative Chemotherapy and Resection for Gastric Cancer

et al. 2020

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“…Favorable HPR, reported in only 33–57% of patients, has been found to serve as an indicator for better clinical outcomes ( 4 - 6 ). Moreover, evaluation of tumor regression after NAC may be beneficial for decision-making regarding postoperative chemotherapy regimens ( 7 , 8 ). Nonetheless, NAC frequently impairs both nutritional status and physical fitness, which may predispose patients towards an elevated risk of postoperative morbidity and mortality ( 9 , 10 ).…”

Section: Introductionmentioning

confidence: 99%

Neoadjuvant chemotherapy-induced severe neutropenia is associated with histopathological response and survival in locally advanced gastric cancer

Wu¹,

Wang²,

Zhou³

et al. 2020

Transl Cancer Res TCR

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Background Neoadjuvant chemotherapy (NAC) has been shown to improve the prognosis for patients with locally advanced gastric cancer (LAGC). Neutropenia, a predominant chemotherapy-related adverse event, affects the therapeutic course for NAC. Methods Data for 233 patients with LAGC treated with NAC and curative gastrectomy at our center were retrospectively analysed in terms of the relationship between neutropenia and clinicopathological features or outcomes. Results NAC-induced neutropenia, NAC-induced severe (grade 3/4) neutropenia (NISN), and a favorable histopathological response (HPR) were observed in 102 (43.8%), 35 (15.0%), and 103 (44.2%) patients, respectively. Together with tumor differentiation, clinical response, and lymphovascular invasion (LVI), and NISN independently predicted a favorable HPR [odds ratio (OR) =4.158, 95% confidence interval (CI): 1.762–9.812, P=0.001). Among patients treated with postoperative chemotherapy, NISN independently predicted poor compliance with postoperative chemotherapy (OR 0.364, 95% CI: 0.148–0.894, P=0.028) and thus poor overall survival (OS) and disease-free survival (DFS). Among patients treated with preoperative chemotherapy alone, NISN was associated with a tendency towards a better DFS (P=0.116) and independently predicted superior OS (hazard ratio =0.253, 95% CI: 0.077–0.830, P=0.023). Conclusions In conclusion, our study revealed a link between NISN, HPR, treatment compliance, and survival. NISN is useful for guiding treatment strategies and predicting prognosis for LAGC patients.

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“…The strengths of this study include the large, multicentre national data sets on which it was based. A large number of variables plausibly related to treatment allocation and/or survival were used to derive the propensity score, and it was possible to include details of chemotherapy regimens and surgical complications, which are lacking in studies conducted using the NCDB [10][11][12]16 . The main limitation of this study is its observational design, but this must be weighed against the importance of the findings made from real-world settings outside very tightly controlled clinical trials.…”

Section: Discussionmentioning

confidence: 99%

“…Research into the benefit of postoperative chemotherapy after NACRT and surgery for oesophageal adenocarcinoma using the US National Cancer Database (NCDB) suggested a survival benefit, particularly when there was residual disease (hazard ratio (HR) 0.69-0.79) [10][11][12] . In contrast, evidence for the benefit of postoperative chemotherapy after preoperative chemotherapy and surgery is limited; one large propensity-matched NCDB study 13 showed no benefit of postoperative chemotherapy in patients with gastric cancer, and small studies [14][15][16] including cancers of the gastro-oesophageal junction (GOJ) have yielded inconsistent results. The aim of this study was to evaluate the survival benefit of postoperative chemotherapy compared with no chemotherapy in patients with OGAC treated with preoperative chemotherapy and surgery in a planned perioperative regimen.…”

Section: Introductionmentioning

confidence: 99%

Impact of postoperative chemotherapy on survival for oesophagogastric adenocarcinoma after preoperative chemotherapy and surgery

Rahman

Thomas

Maynard

et al. 2021

British Journal of Surgery

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Background Perioperative chemotherapy is widely used in the treatment of oesophagogastric adenocarcinoma (OGAC) with a substantial survival benefit over surgery alone. However, the postoperative part of these regimens is given in less than half of patients, reflecting uncertainty among clinicians about its benefit and poor postoperative patient fitness. This study estimated the effect of postoperative chemotherapy after surgery for OGAC using a large population-based data set. Methods Patients with adenocarcinoma of the oesophagus, gastro-oesophageal junction or stomach diagnosed between 2012 and 2018, who underwent preoperative chemotherapy followed by surgery, were identified from a national-level audit in England and Wales. Postoperative therapy was defined as the receipt of systemic chemotherapy within 90 days of surgery. The effectiveness of postoperative chemotherapy compared with observation was estimated using inverse propensity treatment weighting. Results Postoperative chemotherapy was given to 1593 of 4139 patients (38.5 per cent) included in the study. Almost all patients received platinum-based triplet regimens (4004 patients, 96.7 per cent), with FLOT used in 3.3 per cent. Patients who received postoperative chemotherapy were younger, with a lower ASA grade, and were less likely to have surgical complications, with similar tumour characteristics. After weighting, the median survival time after postoperative chemotherapy was 62.7 months compared with 50.4 months without chemotherapy (hazard ratio 0.84, 95 per cent c.i. 0.77 to 0.94; P = 0.001). Conclusion This study has shown that postoperative chemotherapy improves overall survival in patients with OGAC treated with preoperative chemotherapy and surgery.

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The Role of Continuing Perioperative Chemotherapy Post Surgery in Patients with Esophageal or Gastroesophageal Junction Adenocarcinoma: a Multicenter Cohort Study

Cited by 8 publications

References 35 publications

Analysis of the Survival Impact of Postoperative Chemotherapy After Preoperative Chemotherapy and Resection for Gastric Cancer

Analysis of the Survival Impact of Postoperative Chemotherapy After Preoperative Chemotherapy and Resection for Gastric Cancer

Neoadjuvant chemotherapy-induced severe neutropenia is associated with histopathological response and survival in locally advanced gastric cancer

Impact of postoperative chemotherapy on survival for oesophagogastric adenocarcinoma after preoperative chemotherapy and surgery

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