The postoperative part of perioperative chemotherapy fails to provide a survival benefit in completely resected esophagogastric adenocarcinoma

• Published in: Surgical oncology 2020-06, Vol.33, p.177-188
• Main Authors: Sisic, Leila, Blank, Susanne, Nienhüser, Henrik, Haag, Georg Martin, Jäger, Dirk, Bruckner, Tom, Ott, Katja, Schmidt, Thomas, Ulrich, Alexis
• Format: Article
• Language: English
• Subjects: Adenocarcinoma; Adenocarcinoma - drug therapy; Adenocarcinoma - pathology; Adjuvant chemotherapy; Adult; Age Factors; Aged; Aged, 80 and over; Cancer therapies; Cardiovascular disease; Case-Control Studies; Chemotherapy; Chemotherapy, Adjuvant; Classification; Convalescence; Endoscopy; Esophageal cancer; Esophageal Neoplasms - drug therapy; Esophageal Neoplasms - pathology; Esophagectomy; Esophagogastric Junction; Esophagus; Female; Gastric cancer; Humans; Intestine; Localization; Logistic Models; Lymph Node Excision; Lymphatic system; Male; Margins of Excision; Medical prognosis; Meta-analysis; Middle Aged; Morbidity; Neoadjuvant Therapy; Odds Ratio; Patients; Perioperative Care; Perioperative chemotherapy; Postoperative period; Prognosis; Regression analysis; Stomach Neoplasms - drug therapy; Stomach Neoplasms - pathology; Studies; Subgroups; Surgery; Surgical outcomes; Survival; Survival Rate; Tumors
• ISSN: 0960-7404; 1879-3320
• DOI: 10.1016/j.suronc.2017.06.001

Based on two benchmark studies perioperative chemotherapy (CTx) has become standard treatment for locally advanced esophagogastric adenocarcinoma (EGA) in Europe. However, only half of the patients in both studies actually received postoperative CTx (aCTx). Thus, we evaluated the prognostic impact of preoperative CTx (nCTx) and aCTx combined versus nCTx alone. Furthermore, we aimed to identify subgroups potentially beneficial of aCTx and factors associated with its non-administration. We retrospectively analyzed 299 consecutive patients with EGA, who underwent complete resection (all M0, R0) after nCTx in our institution and were eligible for aCTx. Patients with and without aCTx were compared regarding clinicopathological data, treatment, morbidity, and long-term prognosis. 129 patients (43.1%) did not receive aCTx. Administration of aCTx did not significantly improve overall (OS) and recurrence free survival (RFS) (median OS: 78.2 months vs. not reached, p = 0.331; RFS: 43.3 vs. 41.1 months, p = 0.118), but was an independent positive predictor of RFS (HR 1.6 95%CI 1.1–2.5, p = 0.024). aCTx improved RFS in non-intestinal tumors (p = 0.023) and patients receiving FLOT regimen (p = 0.038). By logistic regression analysis factors predictive of non-administration of aCTx were older age (>65 years: OR 3.2, p = 0.028), longer hospital stay (15–28 days: OR 2.6, p = 0.001; >28 days: OR 5.2, p