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Facing adenocarcinoma of distal esophagus and esophagogastric junction: a CROSS versus FLOT propensity score-matched analysis of oncological outcomes in a high-volume institution

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Abstract

Multimodality treatments are the gold standard for advanced resectable gastroesophageal cancer. Neoadjuvant CROSS and perioperative FLOT regimens are adopted for distal esophageal and esophagogastric junction adenocarcinoma (DE/EGJ AC). At present, none of the approaches is clearly superior in the context of a curative-intent multimodal treatment. We analyzed consecutive patients treated with CROSS or FLOT and surgery for DE/EGJ AC between August 2017 and October 2021. Propensity score matching was performed to balance baseline characteristics of patients. The primary endpoint was disease-free survival. Secondary endpoints included overall survival, 90-day morbidity/mortality rates, pathological complete response, margin-negative resection, and pattern of recurrence. Of the 111 patients included, 84 were correctly matched after PSM, 42 in each group. The 2-year DFS rate was 54.2% versus 64.1% in the CROSS and FLOT group, respectively (p = 0.182). Patients in the CROSS group showed a lower number of harvested LN when compared to the FLOT group (29.5 versus 39.0 respectively, p = 0.005). A higher rate of distal nodal recurrence was found in the CROSS group (23.8% versus 4.8%, p = 0.026). Although not significant, the CROSS group showed a trend toward higher rate of isolated distant recurrence (33.3% versus 21.4% respectively, p = 0.328), together with a higher rate of early recurrence (23.8% versus 9.5% respectively, p = 0.062). FLOT and CROSS regimens for DE/EGJ AC offer similar DFS and OS, together with comparable morbidity/mortality rates. CROSS regimen was associated with a higher distant nodal recurrence rate. Results of ongoing randomized clinical trials are awaited.

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Acknowledgements

The authors would thank Ilaria Parisi and Sara De Simone for their valuable help in technical aspects during study setting. The authors would also thank Tommaso Cristoferi, Ayumi Shintani and Yoshinobu Kanda for their valuable advice during statistical analysis.

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The authors received no funding for this research.

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Author notes

  1. Pietro Maria Lombardi and Andrea Pansa have shared co-authorship as first authors.

Authors and Affiliations

  1. Upper Gastrointestinal Surgery Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy

    Pietro Maria Lombardi, Andrea Pansa, Silvia Basato, Lorenzo Giorgi, Vittoria Perano, Salvatore Marano & Carlo Castoro

  2. Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072, Milan, Italy

    Andrea Pansa, Lorenzo Giorgi, Vittoria Perano & Carlo Castoro

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  1. Pietro Maria Lombardi
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Correspondence to Andrea Pansa.

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All patients were provided with informed consent for anonymized clinical data usage. This research study was conducted retrospectively from data obtained for clinical purposes and required no ethical approval. The study was conducted in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Lombardi, P.M., Pansa, A., Basato, S. et al. Facing adenocarcinoma of distal esophagus and esophagogastric junction: a CROSS versus FLOT propensity score-matched analysis of oncological outcomes in a high-volume institution. Updates Surg 75, 921–930 (2023). https://doi.org/10.1007/s13304-023-01497-5

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