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

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Purpose

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.

Methods

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.

Results

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).

Conclusions

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.

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Acknowledgements

G. Papaxoinis received a scholar by the Hellenic Society of Medical Oncology (HeSMO).

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Authors and Affiliations

  1. Department of Medical Oncology, The Christie NHS Foundation Trust, 550 Wilmslow Road, Manchester, M20 4BX, UK

    George Papaxoinis, Jamie M. J. Weaver, Zoe Kordatou, Sofia Stamatopoulou, Theodora Germetaki, Magdy Nasralla, Vikki Owen-Holt & Wasat Mansoor

  2. Department of Medical Oncology, The Mid Yorkshire Hospitals NHS Trust, Wakefield, UK

    Konstantinos Kamposioras

  3. Department of Medical Oncology, The Leeds Teaching Hospitals NHS Trust, Leeds, UK

    Alan Anthoney

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Contributions

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.

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Correspondence to Wasat Mansoor.

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George Papaxoinis and Konstantinos Kamposioras are joint first authors.

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Papaxoinis, G., Kamposioras, K., Weaver, J.M.J. et al. The Role of Continuing Perioperative Chemotherapy Post Surgery in Patients with Esophageal or Gastroesophageal Junction Adenocarcinoma: a Multicenter Cohort Study. J Gastrointest Surg 23, 1729–1741 (2019). https://doi.org/10.1007/s11605-018-04087-8

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