Short-term outcome of Ivor Lewis esophagectomy following neoadjuvant chemoradiation versus perioperative chemotherapy in patients with locally advanced adenocarcinoma of the esophagus and gastroesophageal junction: a propensity score-matched analysis

Abstract

Background Patients with locally advanced esophageal or gastroesophageal adenocarcinoma benefit from multimodal therapy concepts including neoadjuvant chemoradiation (nCRT), respectively, perioperative chemotherapy (pCT). However, it remains unclear which treatment is superior concerning postoperative morbidity. Methods In this study, we compared the postsurgical survival (30-day/90-day/1-year mortality) (primary endpoint), treatment response, and surgical complications (secondary endpoints) of patients who either received nCRT (CROSS protocol) or pCT (FLOT protocol) due to esophageal/gastroesophageal adenocarcinoma. Between January 2013 and December 2017, 873 patients underwent Ivor Lewis esophagectomy in our high-volume center. 339 patients received nCRT and 97 underwent pCT. After 1:1 propensity score matching (matching criteria: sex, age, BMI, ASA score, and Charlson score), 97 patients per subgroup were included for analysis. Results After matching, tumor response (ypT/ypN) did not differ significantly between nCRT and pCT (p = 0.118, respectively, p = 0.174). Residual nodal metastasis occurred more often after pCT (p = 0.001). Postsurgical mortality was comparable within both groups. No patient died within 30 or 90 days after surgery while the 1-year survival rate was 72.2% for nCRT and 68.0% for pCT (p = 0.47). Only grade 3a complications according to Clavien–Dindo were increased after pCT (p = 0.04). There was a trend towards a higher rate of pylorospasm within the pCT group (nCRT: 23.7% versus pCT: 37.1%) (p = 0.061). Multivariate analysis identified pCT, younger age, and Charlson score as independent variables for pylorospasm. Conclusion Both nCRT and pCT are safe and efficient within the multimodal treatment of esophageal/gastroesophageal adenocarcinoma. We did not observe differences in postoperative morbidity. However, functional aspects such as gastric emptying might be more frequent after pCT.

Treatments for resectable esophageal cancer: from traditional systemic therapy to immunotherapy

“…A subsequent large phase II/III trial, the FLOT4 trial, used a docetaxel-based triplet FLOT (Fluorouracil plus Leucovorin, Oxaliplatin, and Docetaxel) regimen and showed a superior R0 resection rate (85% vs. 78%; P = 0.0162), OS (median OS, 50 months vs. 35 months; HR, 0.77; 95% CI, 0.63–0.94), and DFS (HR, 0.75; 95% CI, 0.62–0.91; P = 0.0036) compared with the regimen in MAGIC trial [12] . A recent score-matched study compared the therapeutic outcomes of NCRT and PCT [13] . The results exhibited that these two mainstream regimens showed no significant differences in tumor response and survival rates.…”

“…[ 12 ] A recent score-matched study compared the therapeutic outcomes of NCRT and PCT. [ 13 ] The results exhibited that these two mainstream regimens showed no significant differences in tumor response and survival rates. TRAEs were more common after PCT (42/97 vs. 30/97; P = 0.04).…”

Fructose-1,6-bisphosphatase 1 (FBP1) is an independent biomarker associated with a favorable prognosis in esophageal adenocarcinoma

“…The standard surgical procedure was laparotomic or laparoscopic gastrolysis and right transthoracic en bloc esophagectomy including two-field lymphadenectomy of mediastinal and abdominal lymph nodes. Reconstruction was performed by high intrathoracic esophagogastrostomy as described previously (Plum et al 2021 ; Hölscher et al 2007 ). Patients with advanced esophageal cancer (cT1N1M0 or cT2-3N0-1M0) received preoperative chemoradiation (5-FU, cisplatin, 40 Gy as treated analog the CROSS trial) or perioperative chemotherapy following the FLOT regime (Hagen et al 2012 ; Al-batran et al 2008 ).…”

“…Clinical data were collected prospectively and analyzed according to a standardized protocol as previously described (Plum et al 2021 ; Plum et al 2020 ; Plum et al 2019 ). SPSS Statistics for Mac (Version 21, SPSS) was used for statistical analysis.…”

Immunotherapy for Esophageal Cancers: What Is Practice Changing in 2021?

“…Furthermore, a recently published propensity score-matched analysis comparing the postsurgical survival (30-day/90-day/1-year mortality), treatment response, and surgical complications of patients with AC who received either the CROSS (339 patients) or the FLOT protocol (97 patients) showed no significant differences between both groups [16]. However, so far there are no results of large randomized trials to compare neoadjuvant chemoradiotherapy as used in the CROSS regimen and taxane-based perioperative chemotherapy as used in the FLOT trial in terms of overall survival.…”