Facing adenocarcinoma of distal esophagus and esophagogastric junction: a CROSS versus FLOT propensity score-matched analysis of oncological outcomes in a high-volume institution.
Chemoradiation
Chemotherapy
Esophagectomy
Gastroesophageal cancer
Survival
Journal
Updates in surgery
ISSN: 2038-3312
Titre abrégé: Updates Surg
Pays: Italy
ID NLM: 101539818
Informations de publication
Date de publication:
Jun 2023
Jun 2023
Historique:
received:
06
02
2023
accepted:
20
03
2023
medline:
23
6
2023
pubmed:
30
3
2023
entrez:
29
3
2023
Statut:
ppublish
Résumé
Multimodality treatments are the gold standard for advanced resectable gastroesophageal cancer. Neoadjuvant CROSS and perioperative FLOT regimens are adopted for distal esophageal and esophagogastric junction adenocarcinoma (DE/EGJ AC). At present, none of the approaches is clearly superior in the context of a curative-intent multimodal treatment. We analyzed consecutive patients treated with CROSS or FLOT and surgery for DE/EGJ AC between August 2017 and October 2021. Propensity score matching was performed to balance baseline characteristics of patients. The primary endpoint was disease-free survival. Secondary endpoints included overall survival, 90-day morbidity/mortality rates, pathological complete response, margin-negative resection, and pattern of recurrence. Of the 111 patients included, 84 were correctly matched after PSM, 42 in each group. The 2-year DFS rate was 54.2% versus 64.1% in the CROSS and FLOT group, respectively (p = 0.182). Patients in the CROSS group showed a lower number of harvested LN when compared to the FLOT group (29.5 versus 39.0 respectively, p = 0.005). A higher rate of distal nodal recurrence was found in the CROSS group (23.8% versus 4.8%, p = 0.026). Although not significant, the CROSS group showed a trend toward higher rate of isolated distant recurrence (33.3% versus 21.4% respectively, p = 0.328), together with a higher rate of early recurrence (23.8% versus 9.5% respectively, p = 0.062). FLOT and CROSS regimens for DE/EGJ AC offer similar DFS and OS, together with comparable morbidity/mortality rates. CROSS regimen was associated with a higher distant nodal recurrence rate. Results of ongoing randomized clinical trials are awaited.
Identifiants
pubmed: 36991302
doi: 10.1007/s13304-023-01497-5
pii: 10.1007/s13304-023-01497-5
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
921-930Informations de copyright
© 2023. Italian Society of Surgery (SIC).
Références
Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A et al (2021) Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 71:209–249. https://doi.org/10.3322/caac.21660
doi: 10.3322/caac.21660
pubmed: 33538338
Mariette C, Finzi L, Piessen G, van Seuningen I, Triboulet JP (2005) Esophageal carcinoma: Prognostic differences between squamous cell carcinoma and adenocarcinoma. World J Surg 29:39–45. https://doi.org/10.1007/s00268-004-7542-x
doi: 10.1007/s00268-004-7542-x
pubmed: 15599738
Ajani JA, D’Amico TA, Bentrem DJ, Chao J, Corvera C, Das P et al (2019) Esophageal and esophagogastric junction cancers, Version 2.2019, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Cancer Netw 17:855–883. https://doi.org/10.6004/jnccn.2019.0033
doi: 10.6004/jnccn.2019.0033
Popper U, Rumpold H (2021) Update ESMO: gastric and esophageal cancer. Memo Mag Eur Med Oncol 14:180–183. https://doi.org/10.1007/s12254-021-00694-5
doi: 10.1007/s12254-021-00694-5
Nobel T, Molena D (2019) Surgical principles for optimal treatment of esophagogastric junction adenocarcinoma. Ann Gastroenterol Surg 3:390–395. https://doi.org/10.1002/ags3.12268
doi: 10.1002/ags3.12268
pubmed: 31346578
pmcid: 6635683
Al-Batran SE, Homann N, Pauligk C, Goetze TO, Meiler J, Kasper S et al (2019) Perioperative chemotherapy with fluorouracil plus leucovorin, oxaliplatin, and docetaxel versus fluorouracil or capecitabine plus cisplatin and epirubicin for locally advanced, resectable gastric or gastro-oesophageal junction adenocarcinoma (FLOT4): a randomised, phase 2/3 trial. The Lancet 393:1948–1957. https://doi.org/10.1016/S0140-6736(18)32557-1
doi: 10.1016/S0140-6736(18)32557-1
Cunningham D, Allum WH, Stenning SP, Thompson JN, van de Velde CJ, Nicolson M, et al. Perioperative Chemotherapy versus Surgery Alone for Resectable Gastroesophageal Cancer From the Departments of Medicine (D. vol. 355. 2006.
Ychou M, Boige V, Pignon JP, Conroy T, Bouché O, Lebreton G et al (2011) Perioperative chemotherapy compared with surgery alone for resectable gastroesophageal adenocarcinoma: an FNCLCC and FFCD multicenter phase III trial. J Clin Oncol 29:1715–1721. https://doi.org/10.1200/JCO.2010.33.0597
doi: 10.1200/JCO.2010.33.0597
pubmed: 21444866
van Hagen P, Hulshof MCCM, van Lanschot JJB, Steyerberg EW, van Berge Henegouwen MI, Wijnhoven BPL, et al. Preoperative chemoradiotherapy for esophageal or junctional cancer. 2012.
van den Ende T, Hulshof MCCM, van Berge Henegouwen MI, van Oijen MGH, van Laarhoven HWM (2020) Gastro-oesophageal junction: to FLOT or to CROSS? Acta Oncol (Madr) 59:233–236. https://doi.org/10.1080/0284186X.2019.1698765
doi: 10.1080/0284186X.2019.1698765
Laxague F, Schlottmann F (2021) Esophagogastric junction adenocarcinoma: Preoperative chemoradiation or perioperative chemotherapy? World J Clin Oncol 12:557–564. https://doi.org/10.5306/wjco.v12.i7.557
doi: 10.5306/wjco.v12.i7.557
pubmed: 34367928
pmcid: 8317651
Hoeppner J, Lordick F, Brunner T, Glatz T, Bronsert P, Röthling N et al (2016) ESOPEC: prospective randomized controlled multicenter phase III trial comparing perioperative chemotherapy (FLOT protocol) to neoadjuvant chemoradiation (CROSS protocol) in patients with adenocarcinoma of the esophagus (NCT02509286). BMC Cancer 16:503. https://doi.org/10.1186/s12885-016-2564-y
doi: 10.1186/s12885-016-2564-y
pubmed: 27435280
pmcid: 4952147
Siewert JR, Stein HJ, Feith M (2006) Adenocarcinoma of the esophago-gastric junction. Scand J Surg 95:260–269. https://doi.org/10.1177/145749690609500409
doi: 10.1177/145749690609500409
pubmed: 17249275
Shah J, Fitz-Henry J (2011) Peri-operative care series. Ann R Coll Surg Engl 93:185–187. https://doi.org/10.1308/147870811X565070
doi: 10.1308/147870811X565070
pmcid: 3291130
Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40(5):373–383. https://doi.org/10.1016/0021-9681(87)90171-8
National Cancer Institute. AJCC Cancer Staging Manual 8th Edition. Definitions, Qeios; 2020. https://doi.org/10.32388/B30LDK .
Scarpa M, Cavallin F, Saadeh LM, Pinto E, Alfieri R, Cagol M et al (2016) Hybrid minimally invasive esophagectomy for cancer: impact on postoperative inflammatory and nutritional status. Dis Esophagus 29:1064–1070. https://doi.org/10.1111/dote.12418
doi: 10.1111/dote.12418
pubmed: 26401634
Low DE, Alderson D, Cecconello I, Chang AC, Darling GE, D’Journo XB et al (2015) International consensus on standardization of data collection for complications associated with esophagectomy: Esophagectomy Complications Consensus Group (ECCG). Ann Surg 262:286–294. https://doi.org/10.1097/SLA.0000000000001098
doi: 10.1097/SLA.0000000000001098
pubmed: 25607756
Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD et al (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250:187–196. https://doi.org/10.1097/SLA.0b013e3181b13ca2
doi: 10.1097/SLA.0b013e3181b13ca2
pubmed: 19638912
National Cancer Institute. WHO Classification of Tumors. Definitions, Qeios; 2020. https://doi.org/10.32388/HPU3ES .
Becker K, Langer R, Reim D, Novotny A, Meyer ZumBuschenfelde C, Engel J et al (2011) Significance of histopathological tumor regression after neoadjuvant chemotherapy in gastric adenocarcinomas: a summary of 480 cases. Ann Surg 253:934–939. https://doi.org/10.1097/SLA.0b013e318216f449
doi: 10.1097/SLA.0b013e318216f449
pubmed: 21490451
Ma LX, Panov ED, Allen MJ, Darling GE, Yeung JC, Swallow CJ et al (2022) Preoperative and postoperative approaches to gastroesophageal cancer: what is all the fuss about. JNCCN J Natl Compr Cancer Netw 20:193–202. https://doi.org/10.6004/jnccn.2021.7118
doi: 10.6004/jnccn.2021.7118
Kamarajah SK, Griffiths EA, Oesophago-Gastric Anastomotic Audit (OGAA) Collaborative, Writing group list in the end of manuscript & co-authors listed in the Appendix (2022) Postoperative and pathological outcomes of CROSS and FLOT as neoadjuvant therapy for esophageal and junctional adenocarcinoma: an international cohort study from the oesophagogastric anastomosis audit (OGAA) [published online ahead of print, 2022 Jan 27]. Ann Surg. https://doi.org/10.1097/SLA.0000000000005394
doi: 10.1097/SLA.0000000000005394
pubmed: 35099168
Plum PS, Damanakis A, Buschmann L, Ernst A, Datta RR, Schiffmann LM et al (2022) 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. J Cancer Res Clin Oncol 148:1223–1234. https://doi.org/10.1007/s00432-021-03720-5
doi: 10.1007/s00432-021-03720-5
pubmed: 34223965
Donlon NE, Moran B, Kamilli A et al (2022) CROSS versus FLOT regimens in esophageal and esophagogastric junction adenocarcinoma: a propensity-matched comparison. Ann Surg 276(5):792–798. https://doi.org/10.1097/SLA.0000000000005617
doi: 10.1097/SLA.0000000000005617
pubmed: 35876385
Donlon NE, Kammili A, Roopnarinesingh R, Davern M, Power R, King S et al (2021) FLOT-regimen chemotherapy and transthoracic en bloc resection for esophageal and junctional adenocarcinoma. Ann Surg. 274:814–820. https://doi.org/10.1097/SLA.0000000000005097
doi: 10.1097/SLA.0000000000005097
pubmed: 34310355
Markar SR, Noordman BJ, Mackenzie H, Findlay JM, Boshier PR, Ni M et al (2017) Multimodality treatment for esophageal adenocarcinoma: multi-center propensity-score matched study. Ann Oncol 28:519–527. https://doi.org/10.1093/annonc/mdw560
doi: 10.1093/annonc/mdw560
pubmed: 28039180
Pape M, Vissers PAJ, Beerepoot L, van Berge Henegouwen MI, Lagarde S, Mook S et al (2021) Treatment patterns and overall survival for recurrent esophageal or gastroesophageal junctional cancer: a nationwide European population-based study. J Clin Oncol 39:186–186. https://doi.org/10.1200/JCO.2021.39.3_suppl.186
doi: 10.1200/JCO.2021.39.3_suppl.186
Cools-Lartigue J, Markar S, Mueller C, Hofstetter W, Nilsson M, Ilonen I et al (2022) An international cohort study of prognosis associated with pathologically complete response following neoadjuvant chemotherapy vs. chemoradiotherapy of surgical treated esophageal adenocarcinoma. Ann Surg. https://doi.org/10.1097/SLA.0000000000005619
doi: 10.1097/SLA.0000000000005619
pubmed: 35876385
Meguid RA, Hooker CM, Taylor JT, Kleinberg LR, Cattaneo SM, Sussman MS et al (2009) Recurrence after neoadjuvant chemoradiation and surgery for esophageal cancer: Does the pattern of recurrence differ for patients with complete response and those with partial or no response? J Thorac Cardiovasc Surg 138:1309–1317. https://doi.org/10.1016/j.jtcvs.2009.07.069
doi: 10.1016/j.jtcvs.2009.07.069
pubmed: 19931663
pmcid: 3654695
de Jongh M, Eyck BM, van der Werf LR, Toxopeus ELA, van Lanschot JJB, Lagarde SM et al (2021) Pattern of recurrence in patients with a pathologically complete response after neoadjuvant chemoradiotherapy and surgery for oesophageal cancer. BJS Open. https://doi.org/10.1093/bjsopen/zrab022
doi: 10.1093/bjsopen/zrab022
pubmed: 33876211
pmcid: 8055760