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Survival After Neoadjuvant Therapy Compared with Surgery Alone for Resectable Esophageal Cancer in a Population-based Study

World Journal of Surgery volume 30, pages 2182–2190 (2006)Cite this article

Abstract

Background

Esophagectomy remains the standard treatment for resectable esophageal cancer, but the cure rate is low. Neoadjuvant therapy has been tried in attempts to prolong survival and reduce tumor recurrence. The aim of this study was to assess the surgical outcomes with and without neoadjuvant treatment for resectable esophageal cancer in a population-based setting.

Methods

All 1,155 patients treated with esophagectomy for esophageal cancer in Sweden in 1987 through 2000 with or without neoadjuvant therapy were identified and followed up in nationwide registers up to 18 October 2004. Tumor characteristics and response to neoadjuvant treatment were obtained from histopathological reports. Hazard ratios (HRs) with 95% confidence intervals (CIs) adjusted for potential confounding factors were calculated by a Cox proportional hazards regression model.

Results

Overall survival was similar in the groups with and without neoadjuvant therapy (adjusted HR 0.99, 95% CI 0.86–1.16). The 3-year survival rates were 34.6% and 32.0%, respectively. Survival was better among the 27.6% of the neoadjuvant group with a complete histopathological response (HR 0.71, 95% CI 0.53–0.94) compared with the surgery only group. Patients without complete response to neoadjuvant therapy had seemingly poorer survival (HR 1.10, 95% CI 0.94–1.29).

Conclusions

Surgical outcomes with and without neoadjuvant therapy were equivalent. Only patients with a complete histopathological response after neoadjuvant treatment had better survival.

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References

  1. Jemal A, Murray T, Samuels A, et al. Cancer statistics, 2003. CA Cancer J Clin 2003;53:5–26

    PubMed  Article  Google Scholar 

  2. Berrino F, Gatta G, Chessa E, et al. Introduction: the EUROCARE II Study. Eur J Cancer 1998;34:2139–2153

    CAS  Article  Google Scholar 

  3. De Vita F, Di Martino N, Orditura M, et al. Preoperative chemoradiotherapy for squamous cell carcinoma and adenocarcinoma of the esophagus: a phase II study. Chest 2002;122:1302–1308

    PubMed  Article  Google Scholar 

  4. Enzinger PC, Mayer RJ. Esophageal cancer. N Engl J Med 2003;349:2241–2252

    PubMed  CAS  Article  Google Scholar 

  5. Wu PC, Posner MC. The role of surgery in the management of oesophageal cancer. Lancet Oncol 2003;4:481–488

    PubMed  Article  Google Scholar 

  6. Jamieson GG, Mathew G, Ludemann R, et al. Postoperative mortality following oesophagectomy and problems in reporting its rate. Br J Surg 2004;91:943–947

    PubMed  CAS  Article  Google Scholar 

  7. Viklund PLM, Lu M, Ye W, et al. Risk factors for complications after esophageal cancer resection: a prospective population-based study in Sweden. Ann Surg 2006 (in press)

  8. Trivers KF, De Roos AJ, Gammon MD, et al. Demographic and lifestyle predictors of survival in patients with esophageal or gastric cancers. Clin Gastroenterol Hepatol 2005;3:225–230

    PubMed  Article  Google Scholar 

  9. Zieren HU, Muller JM, Jacobi CA, et al. Adjuvant postoperative radiation therapy after curative resection of squamous cell carcinoma of the thoracic esophagus: a prospective randomized study. World J Surg 1995;19:444–449

    PubMed  CAS  Article  Google Scholar 

  10. Ando N, Iizuka T, Kakegawa T, et al. A randomized trial of surgery with and without chemotherapy for localized squamous carcinoma of the thoracic esophagus: the Japan Clinical Oncology Group Study. J Thorac Cardiovasc Surg 1997;114:205–209

    PubMed  CAS  Article  Google Scholar 

  11. Fujita H, Sueyoshi S, Tanaka T, et al. Prospective non-randomized trial comparing esophagectomy-followed-by-chemoradiotherapy versus chemoradiotherapy-followed-by-esophagectomy for T4 esophageal cancers. J Surg Oncol 2005;90:209–219

    PubMed  Article  Google Scholar 

  12. Roth JA, Pass HI, Flanagan MM, et al. Randomized clinical trial of preoperative and postoperative adjuvant chemotherapy with cisplatin, vindesine, and bleomycin for carcinoma of the esophagus. J Thorac Cardiovasc Surg 1988;96:242–248

    PubMed  CAS  Google Scholar 

  13. Nygaard K, Hagen S, Hansen HS, et al. Pre-operative radiotherapy prolongs survival in operable esophageal carcinoma: a randomized, multicenter study of pre-operative radiotherapy and chemotherapy. The second Scandinavian trial in esophageal cancer. World J Surg 1992;16:1104–1109; discussion 1110

    PubMed  CAS  Article  Google Scholar 

  14. Law S, Fok M, Chow S, et al. Preoperative chemotherapy versus surgical therapy alone for squamous cell carcinoma of the esophagus: a prospective randomized trial. J Thorac Cardiovasc Surg 1997;114:210–217

    PubMed  CAS  Article  Google Scholar 

  15. Kelsen DP, Ginsberg R, Pajak TF, et al. Chemotherapy followed by surgery compared with surgery alone for localized esophageal cancer. N Engl J Med 1998;339:1979–1984

    PubMed  CAS  Article  Google Scholar 

  16. Urschel JD, Vasan H, Blewett CJ. A meta-analysis of randomized controlled trials that compared neoadjuvant chemotherapy and surgery to surgery alone for resectable esophageal cancer. Am J Surg 2002;183:274–279

    PubMed  Article  Google Scholar 

  17. MRC Surgical resection with or without preoperative chemotherapy in oesophageal cancer: a randomised controlled trial. Lancet 2002;359:1727–1733

    Article  Google Scholar 

  18. Launois B, Delarue D, Campion JP, et al. Preoperative radiotherapy for carcinoma of the esophagus. Surg Gynecol Obstet 1981;153:690–692

    PubMed  CAS  Google Scholar 

  19. Gignoux M, Roussel A, Paillot B, et al. The value of preoperative radiotherapy in esophageal cancer: results of a study of the E.O.R.T.C. World J Surg 1987;11:426–432

    PubMed  CAS  Article  Google Scholar 

  20. Arnott SJ, Duncan W, Gignoux M, et al. Preoperative radiotherapy for esophageal carcinoma. Cochrane Database Syst Rev 2000:CD001799

  21. Patel M, Ferry K, Franceschi D, et al. Esophageal carcinoma: current controversial topics. Cancer Invest 2004;22:897–912

    PubMed  CAS  Article  Google Scholar 

  22. Walsh TN, Noonan N, Hollywood D, et al. A comparison of multimodal therapy and surgery for esophageal adenocarcinoma. N Engl J Med 1996;335:462–467

    PubMed  CAS  Article  Google Scholar 

  23. Urba SG, Orringer MB, Turrisi A, et al. Randomized trial of preoperative chemoradiation versus surgery alone in patients with locoregional esophageal carcinoma. J Clin Oncol 2001;19:305–313

    PubMed  CAS  Google Scholar 

  24. Urschel JD, Vasan H. A meta-analysis of randomized controlled trials that compared neoadjuvant chemoradiation and surgery to surgery alone for resectable esophageal cancer. Am J Surg 2003;185:538–543

    PubMed  Article  Google Scholar 

  25. Urba S. Esophageal cancer: preoperative or definitive chemoradiation. Ann Oncol 2004;15(Suppl 4):iv93–96

    PubMed  Google Scholar 

  26. Mattson BWA. Completeness of the Swedish Cancer Registry. Non-notified cancer cases recorded on death certificates in 1978. Acta Radiol 1984;23:305–313

    Google Scholar 

  27. National board of Health and Welfare. Cancer incidence in Sweden 1985. Stockholm Centre for Epidemilology, National board of Health and Welfare, 1988

  28. National board of Health and Welfare. Cancer incidence in Sweden 1995. Stockholm Centre for Epidemiology, National board of Health and Welfare, 1997

  29. National board of Health and Welfare. Classification of Surgical Procedures, National board of Health and Welfare, 1997

  30. Wang M, Gu XZ, Yin WB, et al. Randomized clinical trial on the combination of preoperative irradiation and surgery in the treatment of esophageal carcinoma: report on 206 patients. Int J Radiat Oncol Biol Phys 1989;16:325–327

    PubMed  CAS  Google Scholar 

  31. Arnott SJ, Duncan W, Kerr GR, et al. Low dose preoperative radiotherapy for carcinoma of the oesophagus: results of a randomized clinical trial. Radiother Oncol 1992;24:108–113

    PubMed  CAS  Article  Google Scholar 

  32. Bosset JF, Gignoux M, Triboulet JP, et al. Chemoradiotherapy followed by surgery compared with surgery alone in squamous-cell cancer of the esophagus. N Engl J Med 1997;337:161–167

    PubMed  CAS  Article  Google Scholar 

  33. Burmeister B SM, Triboulet JP, et al. A randomized clinical trial comparing surgery alone with concurrent preoperative chemotherapy and radiation followed by surgery for localized resectable carcinoma of the esophagus. Proc Am Soc Clin Oncol 2002;22:518

    Google Scholar 

  34. Apinop C, Puttisak P, Preecha N. A prospective study of combined therapy in esophageal cancer. Hepatogastroenterology 1994;41:391–393

    PubMed  CAS  Google Scholar 

  35. Le Prise E, Etienne PL, Meunier B, et al. A randomized study of chemotherapy, radiation therapy, and surgery versus surgery for localized squamous cell carcinoma of the esophagus. Cancer 1994;73:1779–1784

    PubMed  CAS  Article  Google Scholar 

  36. Malthaner RA, Wong RK, Rumble RB, et al. Neoadjuvant or adjuvant therapy for resectable esophageal cancer: a clinical practice guideline. BMC Cancer 2004;4:67

    PubMed  Article  Google Scholar 

  37. Greer SE, Goodney PP, Sutton JE, et al. Neoadjuvant chemoradiotherapy for esophageal carcinoma: a meta-analysis. Surgery 2005;137:172–177

    PubMed  Article  Google Scholar 

  38. Frechette E, Buck DA, Kaplan BJ, et al. Esophageal cancer: outcomes of surgery, neoadjuvant chemotherapy, and three-dimension conformal radiotherapy. J Surg Oncol 2004;87:68–74

    PubMed  Article  Google Scholar 

  39. Kaklamanos IG, Walker GR, Ferry K, et al. Neoadjuvant treatment for resectable cancer of the esophagus and the gastroesophageal junction: a meta-analysis of randomized clinical trials. Ann Surg Oncol 2003;10:754–761

    PubMed  Article  Google Scholar 

  40. Fiorica F, Di Bona D, Schepis F, et al. Preoperative chemoradiotherapy for oesophageal cancer: a systematic review and meta-analysis. Gut 2004;53:925–930

    PubMed  CAS  Article  Google Scholar 

  41. Stahl M, Stuschke M, Lehmann N, et al. Chemoradiation with and without surgery in patients with locally advanced squamous cell carcinoma of the esophagus. J Clin Oncol 2005;23:2310–2317

    PubMed  Article  Google Scholar 

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Affiliations

  1. Unit of Esophageal and Gastric Research, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden

    Ioannis Rouvelas, Mats Lindblad, Pernilla Viklund & Jesper Lagergren

  2. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden

    Wenyi Zeng, Weimin Ye & Jesper Lagergren

  3. Department of Mathematics, Beijing Normal University, 100875, Beijing, People’s Republic of China

    Wenyi Zeng

  4. Department of Surgery, Karolinska University Hospital, SE-171 76, Solna, Stockholm, Sweden

    Ioannis Rouvelas

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  1. Ioannis Rouvelas
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  2. Wenyi Zeng
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Correspondence to Ioannis Rouvelas.

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Rouvelas, I., Zeng, W., Lindblad, M. et al. Survival After Neoadjuvant Therapy Compared with Surgery Alone for Resectable Esophageal Cancer in a Population-based Study. World J. Surg. 30, 2182–2190 (2006). https://doi.org/10.1007/s00268-006-0016-6

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  • DOI: https://doi.org/10.1007/s00268-006-0016-6

Keywords

  • Esophageal Cancer
  • Preoperative Chemoradiotherapy
  • Calendar Period
  • Resectable Esophageal Cancer
  • Personal Identity Number