OBJECTIVE: Patients with metastatic gastroesophageal adenocarcinoma (MGEAC) have a poor but heterogeneous clinical course. Some patients have an unusually favorable outcome. We sought to identify clinical variables associated with more favorable outcomes. METHODS: Of 246 patients with MGEAC, we identified 64 who received systemic therapy and eventually received local consolidation therapy. Univariate and multivariate Cox regression models were used, and a nomogram was developed. RESULTS: Of these 64 patients, 61% had received consolidation chemoradiation (CRT) with doses of 50-55 Gy and 78% did not undergo surgery. The median follow-up time of survivors was 3.9 years, and the median overall survival (OS) from CRT start was 1.5 years (95% CI, 1.2-2.2). Surgery (as local consolidation) was an independent prognosticator for longer OS in the multivariate analysis (p = 0.02). The 5-year OS rate was 25% (SE = 6%). The contributors to the nomogram were longer duration of systemic therapy before CRT and the type of local therapy. CONCLUSIONS: Our data suggest that a subset of patients with MGEAC have an excellent prognosis (OS >5 years). However, these patients need to be identified during their clinical course so that local consolidation (CRT, surgery, or both) may be offered.
OBJECTIVE:Patients with metastatic gastroesophageal adenocarcinoma (MGEAC) have a poor but heterogeneous clinical course. Some patients have an unusually favorable outcome. We sought to identify clinical variables associated with more favorable outcomes. METHODS: Of 246 patients with MGEAC, we identified 64 who received systemic therapy and eventually received local consolidation therapy. Univariate and multivariate Cox regression models were used, and a nomogram was developed. RESULTS: Of these 64 patients, 61% had received consolidation chemoradiation (CRT) with doses of 50-55 Gy and 78% did not undergo surgery. The median follow-up time of survivors was 3.9 years, and the median overall survival (OS) from CRT start was 1.5 years (95% CI, 1.2-2.2). Surgery (as local consolidation) was an independent prognosticator for longer OS in the multivariate analysis (p = 0.02). The 5-year OS rate was 25% (SE = 6%). The contributors to the nomogram were longer duration of systemic therapy before CRT and the type of local therapy. CONCLUSIONS: Our data suggest that a subset of patients with MGEAC have an excellent prognosis (OS >5 years). However, these patients need to be identified during their clinical course so that local consolidation (CRT, surgery, or both) may be offered.
Authors: Jaffer A Ajani; Thomas A D'Amico; Khaldoun Almhanna; David J Bentrem; Stephen Besh; Joseph Chao; Prajnan Das; Crystal Denlinger; Paul Fanta; Charles S Fuchs; Hans Gerdes; Robert E Glasgow; James A Hayman; Steven Hochwald; Wayne L Hofstetter; David H Ilson; Dawn Jaroszewski; Kory Jasperson; Rajesh N Keswani; Lawrence R Kleinberg; W Michael Korn; Stephen Leong; A Craig Lockhart; Mary F Mulcahy; Mark B Orringer; James A Posey; George A Poultsides; Aaron R Sasson; Walter J Scott; Vivian E Strong; Thomas K Varghese; Mary Kay Washington; Christopher G Willett; Cameron D Wright; Debra Zelman; Nicole McMillian; Hema Sundar Journal: J Natl Compr Canc Netw Date: 2015-02 Impact factor: 11.908
Authors: S Lorenzen; P Thuss-Patience; S E Al-Batran; F Lordick; B Haller; T Schuster; C Pauligk; K Luley; D Bichev; G Schumacher; N Homann Journal: Ann Oncol Date: 2013-04-16 Impact factor: 32.976
Authors: Jaffer A Ajani; David J Bentrem; Stephen Besh; Thomas A D'Amico; Prajnan Das; Crystal Denlinger; Marwan G Fakih; Charles S Fuchs; Hans Gerdes; Robert E Glasgow; James A Hayman; Wayne L Hofstetter; David H Ilson; Rajesh N Keswani; Lawrence R Kleinberg; W Michael Korn; A Craig Lockhart; Kenneth Meredith; Mary F Mulcahy; Mark B Orringer; James A Posey; Aaron R Sasson; Walter J Scott; Vivian E Strong; Thomas K Varghese; Graham Warren; Mary Kay Washington; Christopher Willett; Cameron D Wright; Nicole R McMillian; Hema Sundar Journal: J Natl Compr Canc Netw Date: 2013-05-01 Impact factor: 11.908
Authors: H G van den Boorn; E G Engelhardt; J van Kleef; M A G Sprangers; M G H van Oijen; A Abu-Hanna; A H Zwinderman; V M H Coupé; H W M van Laarhoven Journal: PLoS One Date: 2018-02-08 Impact factor: 3.240