The Role of Continuing Perioperative Chemotherapy Post Surgery in Patients with Esophageal or Gastroesophageal Junction Adenocarcinoma: a Multicenter Cohort Study
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The aim of this cohort study was to assess the benefit that patients with lower esophageal or gastroesophageal junction (E/GEJ) adenocarcinoma receive by continuing perioperative chemotherapy post-surgery.
Three hundred twelve patients underwent radical tumor surgical resection after preoperative chemotherapy. Chemotherapy was mainly ECX (epirubicin, cisplatin, capecitabine). Propensity score matching (PSM) was used to compare continuation of chemotherapy post-surgery vs. no postoperative treatment.
Two hundred ten patients (67.3%) had GEJ and 102 (32.7%) lower esophageal adenocarcinoma. Microscopically clear surgical margins (R0), according to the Royal College of Pathologists, were achieved in 208 patients (66.7%). In total, 225 patients (72.1%) continued perioperative chemotherapy post-surgery. PSM was used to create two patient groups, well-balanced for basic epidemiological, clinical, and histopathological characteristics. The first included 148 patients who continued perioperative chemotherapy after surgery and the second 86, who did not receive postoperative treatment. The first group had non-significantly different median time-to-relapse (TTR 22.2 vs. 25.7 months, p = 0.627), overall survival (OS 46.1 vs. 36.7 months, p = 0.199), and post-relapse survival (15.3 vs. 8.7 months, p = 0.122). Subgroup analysis showed that only patients with microscopically residual disease after surgery (R1 resection) benefited from continuation of chemotherapy post-surgery for both TTR (hazard ratio [HR] 0.556, 95% CI 0.330–0.936, p = 0.027) and OS (HR 0.530, 95% CI 0.313–0.898, p = 0.018).
Continuation of perioperative chemotherapy post-surgery was not associated with improved outcome in patients with E/GEJ adenocarcinoma. Patients with microscopically residual disease post-surgery might receive a potential benefit from adjuvant chemotherapy.
KeywordsEsophageal–gastroesophageal junction adenocarcinoma Perioperative chemotherapy Adjuvant chemotherapy Propensity score matching analysis Prognosis
G. Papaxoinis received a scholar by the Hellenic Society of Medical Oncology (HeSMO).
GP, KK, AA, and WM participated in the conception and design of the study; GP, KK, JMJW, ZK, SS, TG, MN, VO-H, AA, and WM contributed to the acquisition, analysis, or interpretation of data; GP, KK, AA, and WM drafted the manuscript; GP, KK, JMJW, ZK, SS, TG, MN, VO-H, AA, and WM revised the manuscript critically for important intellectual content; GP, KK, JMJW, ZK, SS, TG, MN, VO-H, AA, and WM approved the final version of the manuscript to be published; GP, KK, JMJW, ZK, SS, TG, MN, VO-H, AA, and WM agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Compliance with Ethical Standards
Conflict of Interest
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