In esophageal cancer, neoadjuvant chemoradiotherapy predicts worse OS

  • Macedo FI & al.
  • Ann Surg Oncol
  • 1 Dec 2019

  • curated by Jim Kling
  • Univadis Clinical Summaries
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Takeaway

  • Neoadjuvant chemoradiation (NACR) is linked to a higher rate of pathologic complete response (pCR), but worse short- and long-term survival, in resectable esophageal cancer.

Why this matters

  • NACR has a survival benefit in squamous cell carcinoma, but it is unclear whether it benefits patients with esophageal cancer more broadly, especially those with adenocarcinoma.

Study design

  • Retrospective analysis of the National Cancer Database (n=12,238).
  • Funding: None disclosed.

Key results

  • 92.1% underwent NACR.
  • There was no significant difference in OS between the neoadjuvant chemotherapy and NACR groups (37.6 vs 35.9 months; P=.393).
  • NACR was associated with a greater frequency of pCR (19.2% vs 6.3%; HR, 2.593; P<.001>
  • pCR response was associated with better 3-year survival (38.4% vs 31.6%; P<.001 but there was no difference in survival among patients with a pcr who had undergone chemotherapy vs nacr not reached months p=".745).</li">
  • Among patients who did not achieve pCR, chemotherapy was associated with better OS (37.3 vs 30.8 months; P=.002), and chemoradiotherapy was associated with higher 90-day mortality (HR, 1.872; P=.036).
  • Cox regression analysis showed that NACR was a predictor of worse OS (HR, 1.561; P<.001>

Limitations

  • Retrospective analysis.