Perioperative Chemotherapy versus Surgery Alone for Resectable Gastroesophageal Cancer

Cunningham, David; Allum, William; Stenning, Sally; Thompson, J. N.; Nicolson, Marianne; Scarffe, J. H.; Lofts, F.; Falk, Stephen; Iveson, Tim; Smith, David B.; Langley, Ruth E.; Verma, Monica; Weeden, Simon; Chua, Yu Jo

doi:10.1056/nejmoa055531

Cited by 5,535 publications

(4,699 citation statements)

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“…Neoadjuvant chemotherapy practice evolved during the study period, and followed standard indications and regimens as supported by RCT evidence3. The small number of patients who received neoadjuvant chemoradiotherapy were excluded.…”

Section: Methodsmentioning

confidence: 99%

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Impact of incremental circumferential resection margin distance on overall survival and recurrence in oesophageal adenocarcinoma

Knight

Zylstra²,

Wulaningsih

et al. 2018

BJS Open

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BackgroundPrevious analyses of the oesophageal circumferential resection margin (CRM) have focused on the prognostic validity of two different definitions of a positive CRM, that of the College of American Pathologists (tumour at margin) and that of the Royal College of Pathologists (tumour within 1 mm). This study aimed to analyse the validity of these definitions and explore the risk of recurrence and survival with incremental tumour distances from the CRM.MethodsThis cohort study included patients who underwent resection for adenocarcinoma of the oesophagus between 2000 and 2014. Kaplan–Meier and Cox regression analyses were performed to determine the hazard ratio (HR) with 95 per cent confidence intervals for recurrence and mortality in CRM increments: tumour at the cut margin, extending to within 0·1–0·9, 1·0–1·9, 2·0–4·9 mm, and 5·0 mm or more from the margin.ResultsA total of 444 patients were included in the study. Kaplan–Meier and unadjusted analyses showed a significant incremental improvement in overall survival (P < 0·001) and recurrence (P for trend < 0·001) rates with increasing distance from the CRM. Tumour distance of 2·0 mm or more remained a significant predictor of survival on multivariable analysis (HR for risk of death 0·66, 95 per cent c.i. 0·44 to 1·00). Multivariable analysis of overall survival demonstrated a significant difference between a positive and negative CRM with the Royal College of Pathologists' definition (HR 1·37, 1·01 to 1·85), but not with the College of American Pathologists' definition (HR 1·22, 0·90 to 1·65).ConclusionThis study demonstrated an incremental improvement in survival and recurrence rates with increasing tumour distance from the CRM.

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Section: Methodsmentioning

confidence: 99%

“…The introduction of neoadjuvant treatment has increased the survival of patients undergoing surgery for oesophageal cancer1, 2, 3. Despite this, 5‐year survival rates following resection rarely exceed 50 per cent, and recurrence rates are still disappointingly high.…”

Section: Introductionmentioning

confidence: 99%

Impact of incremental circumferential resection margin distance on overall survival and recurrence in oesophageal adenocarcinoma

Knight

Zylstra²,

Wulaningsih

et al. 2018

BJS Open

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“…The practice of NAC evolved during the study period and followed standard indications and regimens, as supported by RCT evidence9. Surgical resection included transthoracic (TTO) or transhiatal (THO) oesophagectomy, determined by tumour characteristics and individual surgeon preference.…”

Section: Methodsmentioning

confidence: 99%

“…Systemic recurrence remains the most common cause of death following oesophageal resection and, as a result, most patients are offered oncological therapies in combination with surgery, in the hope of reducing this risk7. Neoadjuvant chemotherapy (NAC) and neoadjuvant chemoradiotherapy (NACRT) have both been shown to improve survival compared with surgery alone7, 8, 9. Although both may have a local downstaging effect on the primary tumour, this is widely acknowledged to be more pronounced following NACRT8.…”

Section: Introductionmentioning

confidence: 99%

Patterns of recurrence in oesophageal cancer following oesophagectomy in the era of neoadjuvant chemotherapy

Knight

Zylstra²,

Hemelrijck

et al. 2017

BJS Open

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BackgroundTumour recurrence following oesophagectomy for oesophageal cancer is common despite neoadjuvant treatment. Understanding patterns of recurrence and risk factors associated with locoregional and systemic recurrence might influence future treatment strategies.MethodsThis was a cohort study involving patients undergoing resection for adenocarcinoma or squamous cell carcinoma of the oesophagus between 2000 and 2014. Clinicopathological factors associated with locoregional and systemic recurrence were analysed using multivariable logistic regression to determine odds ratios (ORs) and 95 per cent confidence intervals.ResultsSome 698 patients were identified. Lymphovascular invasion (OR 2·09, 95 per cent c.i. 1·18 to 3·71) and preoperative stenting (OR 3·70, 1·34 to 10·23) were independent risk factors for isolated locoregional recurrence. Pathological nodal disease in patients with pT1–2 (pN1: OR 2·72, 1·35 to 5·48; pN2–3: OR 5·00, 2·35 to 10·66) or pT3–4 (pN1: OR 3·03, 1·51 to 6·07; pN2–3: OR 5·75, 3·15 to 10·49) disease predisposed to systemic recurrence. Poor or no response to chemotherapy was also an independent risk factor for isolated systemic recurrence (OR 1·85, 1·05 to 3·26). A positive resection margin (R1 resection) was not associated with a significantly increased risk of isolated locoregional recurrence (OR 1·37, 0·81 to 2·33).ConclusionThese findings confirm that oesophageal adenocarcinoma is frequently a systemic disease. Understanding the key predictors of local and systemic recurrence may facilitate the tailoring of oncological therapies to the individual patient.

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“…[5][6][7] Thus, over time, these important contributions have translated into treatment recommendations and guidelines to improve the quality of care and survival outcomes of gastric cancer in the United States.…”

mentioning

confidence: 99%

Variations in gastric cancer care

Al‐Refaie

Virnig

Tseng

et al. 2009

Cancer

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BACKGROUND:Race is associated with patterns of presentation and survival outcomes of gastric cancer in the United States. However, the impact of race on the receipt of guideline‐recommended care is not well characterized. By using current recommendations, the authors examined the association between race and guideline‐recommended treatments and identified factors that are predictive of variations in gastric cancer care.METHODS:By using the National Cancer Database for 1998 through 2005, 106,002 patients with gastric adenocarcinoma were identified. Multivariate analysis techniques were used to examine the association between race, the receipt of guideline‐recommended care, and survival after adjusting for covariates.RESULTS:Although African‐American and Hispanic patients were more likely to undergo adequate lymphadenectomy (≥15 lymph nodes) and to receive care at comprehensive cancer centers and high‐volume facilities (for all, P ≤ .001), they were less likely to receive adjuvant multimodality therapy for American Joint Committee on Cancer stage IB through IV, lymph node‐negative (M0) disease. Up to 60% of all patients who underwent gastrectomy failed to receive adequate lymphadenectomy and adjuvant multimodality therapy. The delivery of multimodality therapy varied significantly by stage and lymph node evaluation (P ≤ .001). These findings persisted on our multivariate analyses, indicating that African‐American and Hispanic patients received adequate lymph node evaluation (P ≤ .001), whereas they were associated with receiving no adjuvant multimodality therapy (P ≤ .025).CONCLUSIONS:There were significant variations in treatment for gastric cancer among ethnic groups in the United States. It was noteworthy that, although nonwhite race was associated with improved surgical care, gastric cancer care remained suboptimal overall. Cancer programs need to identify procedures to maximize the delivery of adequate gastric cancer care to all patients. Cancer 2010. © 2010 American Cancer Society.

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Perioperative Chemotherapy versus Surgery Alone for Resectable Gastroesophageal Cancer

Abstract: In patients with operable gastric or lower esophageal adenocarcinomas, a perioperative regimen of ECF decreased tumor size and stage and significantly improved progression-free and overall survival. (Current Controlled Trials number, ISRCTN93793971 [controlled-trials.com].).

Cited by 5,535 publications

References 19 publications

Impact of incremental circumferential resection margin distance on overall survival and recurrence in oesophageal adenocarcinoma

Impact of incremental circumferential resection margin distance on overall survival and recurrence in oesophageal adenocarcinoma

Patterns of recurrence in oesophageal cancer following oesophagectomy in the era of neoadjuvant chemotherapy

Variations in gastric cancer care

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