Arnaud Pasquer1, Caroline Gronnier2,3,4,5, Florence Renaud5,6, Alain Duhamel5,7, Jérémie Théreaux8, Nicolas Carrere9, Johan Gagniere10, Bernard Meunier11, Denis Collet12, Christophe Mariette13,14,15,16. 1. Department of Digestive Surgery, Edouard Herriot University Hospital, Lyon, France. 2. Department of Digestive and Oncological Surgery, University Hospital Claude Huriez, Regional University Hospital Center, Place de Verdun, Lille Cedex, France. 3. North of France University, Lille Cedex, France. 4. Inserm, UMR S-1172, Team 5 "Mucins, Epithelial Differentiation and Carcinogenesis," JPARC, Lille Cedex, France. 5. SIRIC OncoLille, Lille Cedex, France. 6. Department of Pathology, Lille University Hospital, Lille Cedex, France. 7. Department of Biostatistics, University Hospital, Lille Cedex, France. 8. Cavale Blanche University Hospital, Brest, France. 9. Purpan University Hospital, Toulouse, France. 10. Estaing University Hospital, Clermont-Ferrand, France. 11. Pontchaillou University Hospital, Rennes, France. 12. Haut-Levêque University Hospital, Bordeaux, France. 13. Department of Digestive and Oncological Surgery, University Hospital Claude Huriez, Regional University Hospital Center, Place de Verdun, Lille Cedex, France. christophe.mariette@chru-lille.fr. 14. North of France University, Lille Cedex, France. christophe.mariette@chru-lille.fr. 15. Inserm, UMR S-1172, Team 5 "Mucins, Epithelial Differentiation and Carcinogenesis," JPARC, Lille Cedex, France. christophe.mariette@chru-lille.fr. 16. SIRIC OncoLille, Lille Cedex, France. christophe.mariette@chru-lille.fr.
Abstract
BACKGROUND: Whereas the optimal therapeutic strategy in node positive esophageal cancer primarily treated by surgery remains unknown, the study was designed to evaluate the impact of adjuvant chemotherapy on survival in such population. METHODS: Among 2944 consecutive patients operated on for esophageal cancer between 2000 and 2010 in 30 European centers, patients with lymph node metastasis treated by adjuvant treatment (n = 178) were compared to patients who did not received adjuvant treatment (n = 378). Multivariable analyses and propensity score matching were used to compensate for differences in baseline characteristics. RESULTS: After matching, patients were comparable between the two groups. When comparing adjuvant treatment and nonadjuvant treatment groups, there was no significant differences in 3-year overall (40.9 vs. 35.8 %, P = 0.560) and disease-free (33.9 vs. 28.5 %, P = 0.190) survivals. Locoregional recurrence was lower in the adjuvant treatment group (14.4 vs. 30.9 %, P = 0.012). In the adjuvant treatment group, 94 patients received chemotherapy and 84 chemoradiotherapy, without significant survival benefit over chemoradiotherapy compared with chemotherapy alone (P = 0.280). Predictive factors of overall survival were age ≥60 years, ASA III-IV score, and pN+ classification. No survival benefit was observed according to histological subtype or occurrence of postoperative complications. CONCLUSIONS: Adjuvant chemo(radio)therapy did not offer survival benefit in lymph node-positive esophageal cancer patients primarily treated with surgery.
BACKGROUND: Whereas the optimal therapeutic strategy in node positive esophageal cancer primarily treated by surgery remains unknown, the study was designed to evaluate the impact of adjuvant chemotherapy on survival in such population. METHODS: Among 2944 consecutive patients operated on for esophageal cancer between 2000 and 2010 in 30 European centers, patients with lymph node metastasis treated by adjuvant treatment (n = 178) were compared to patients who did not received adjuvant treatment (n = 378). Multivariable analyses and propensity score matching were used to compensate for differences in baseline characteristics. RESULTS: After matching, patients were comparable between the two groups. When comparing adjuvant treatment and nonadjuvant treatment groups, there was no significant differences in 3-year overall (40.9 vs. 35.8 %, P = 0.560) and disease-free (33.9 vs. 28.5 %, P = 0.190) survivals. Locoregional recurrence was lower in the adjuvant treatment group (14.4 vs. 30.9 %, P = 0.012). In the adjuvant treatment group, 94 patients received chemotherapy and 84 chemoradiotherapy, without significant survival benefit over chemoradiotherapy compared with chemotherapy alone (P = 0.280). Predictive factors of overall survival were age ≥60 years, ASA III-IV score, and pN+ classification. No survival benefit was observed according to histological subtype or occurrence of postoperative complications. CONCLUSIONS: Adjuvant chemo(radio)therapy did not offer survival benefit in lymph node-positive esophageal cancerpatients primarily treated with surgery.
Authors: Carrie Luu; Marisa Amaral; Jason Klapman; Cynthia Harris; Khaldoun Almhanna; Sarah Hoffe; Jessica Frakes; Jose M Pimiento; Jacques P Fontaine Journal: World J Gastroenterol Date: 2017-12-14 Impact factor: 5.742