Management of Clinical T2N0 Esophageal and Gastroesophageal Junction Adenocarcinoma: What Is the Optimal Treatment?

Autor: Perez Holguin RA; Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA., Olecki EJ; Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA., Stahl KA; Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA., Wong WG; Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA., Vining CC; Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA.; Division of Surgical Oncology, Department of Surgery, College of Medicine, The Pennsylvania State University, 500 University Drive, Hershey, PA, H07017033, USA., Dixon MEB; Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA.; Division of Surgical Oncology, Department of Surgery, College of Medicine, The Pennsylvania State University, 500 University Drive, Hershey, PA, H07017033, USA., Peng JS; Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA. jpeng1@pennstatehealth.psu.edu.; Division of Surgical Oncology, Department of Surgery, College of Medicine, The Pennsylvania State University, 500 University Drive, Hershey, PA, H07017033, USA. jpeng1@pennstatehealth.psu.edu.
Jazyk: angličtina
Zdroj: Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract [J Gastrointest Surg] 2022 Oct; Vol. 26 (10), pp. 2050-2060. Date of Electronic Publication: 2022 Aug 30.
DOI: 10.1007/s11605-022-05441-7
Abstrakt: Background: The current standard of care for locally advanced esophageal and gastroesophageal junction (GEJ) adenocarcinoma includes neoadjuvant chemoradiation and surgery. The optimal treatment for clinical T2N0M0 (cT2N0) disease is debated. This study aims to determine the optimal treatment in these patients.
Methods: The National Cancer Database was used to identify patients who underwent surgery for cT2N0 esophageal and GEJ adenocarcinoma from 2004 to 2017. Patients were grouped into surgery-alone, neoadjuvant therapy (NAT), and adjuvant therapy (AT) groups. Subgroups of high-risk patients (tumor ≥ 3 cm, poor differentiation, or lymphovascular invasion) and patients upstaged after upfront surgery were identified. Kaplan-Meier method and Cox proportional hazard ratios were used to compare overall survival.
Results: Of 2160 patients included, 957 (44.3%) underwent surgery-alone, 821 (38.0%) underwent NAT and surgery, and 382 (17.7%) underwent surgery and AT. One thousand six hundred nineteen (75.0%) patients had high-risk features. Six hundred fourteen (45.9%) patients were upstaged after upfront surgery. In the overall cohort, AT was associated with improved survival compared to NAT (HR 0.618, p < 0.001) and surgery-alone (HR 0.699, p < 0.001). There was no difference in survival between NAT and surgery-alone (HR 1.132, p = 0.112). Similar results were observed in high-risk patients. Patients upstaged after upfront surgery who received AT had improved survival compared to those initially treated with NAT (HR 0.613, p < 0.001).
Conclusion: This analysis suggests that cT2N0 esophageal and GEJ adenocarcinomas may not benefit from the intensive multimodality therapy utilized in locally advanced disease. Selective use of AT for patients who are upstaged pathologically, or have high-risk features, is associated with improved outcomes.
(© 2022. The Society for Surgery of the Alimentary Tract.)
Databáze: MEDLINE
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