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Multicentre study of neoadjuvant chemotherapy for stage I and II oesophageal cancer

Bekkar S, Gronnier C, Renaud F, Duhamel A, Pasquer A, Théreaux J, Gagnière J, Meunier B, Collet D, Mariette C; French Eso-Gastric Tumors (FREGAT) working group, Fédération de Recherche EN CHirurgie (FRENCH) and Association Française de Chirurgie (AFC)

Br J Surg. 2016 Apr 4. [Epub ahead of print]

Editorial comment from Professor David Cunningham:
This month, there are a number of interesting studies published relating to the neoadjuvant treatment of oesophageal cancer. In the British Journal of Surgery, Bekkar et al. present the results of a large retrospective European study on the effects of neoadjuvant chemoradiotherapy on Stage I and II oesophageal cancer, a group of patients which are less well represented in clinical trials. Using propensity matched scoring to adjust for differences in baseline characteristics, they demonstrate that patients treated with neoadjuvant chemotherapy (typically cisplatin and fluoropyrimidine based) had better disease free and overall survival compared to those who did not receive pre-operative chemotherapy. The improvement in overall survival appeared to be driven by a reduction in distant metastases (21.9% vs. 27.1%; p = 0·035) as loco-regional recurrences and mixed recurrences occurred at similar rates in both groups. The study emphasised that understaging is common in patients with clinical Stage I and II disease, almost one third of patients had pathological stage III disease at surgery. This further supports a neo-adjuvant chemotherapy approach as micrometastases which lead to recurrence are more common in Stage III cancers and these may be eliminated by chemotherapy.

Abstract
 

BACKGROUND:

The benefit of neoadjuvant chemotherapy (NCT) for early-stage oesophageal cancer is unknown. The aim of this study was to assess whether NCT improves the outcome of patients with stage I or II disease.

METHODS:

Data were collected from 30 European centres from 2000 to 2010. Patients who received NCT for stage I or II oesophageal cancer were compared with patients who underwent primary surgery with regard to postoperative morbidity, mortality, and overall and disease-free survival. Propensity score matching was used to adjust for differences in baseline characteristics.

RESULTS:

Of 1173 patients recruited (181 NCT, 992 primary surgery), 651 (55·5 per cent) had clinical stage I disease and 522 (44·5 per cent) had stage II disease. Comparisons of the NCT and primary surgery groups in the matched population (181 patients in each group) revealed in-hospital mortality rates of 4·4 and 5·5 per cent respectively (P = 0·660), R0 resection rates of 91·7 and 86·7 per cent (P = 0·338), 5-year overall survival rates of 47·7 and 38·6 per cent (hazard ratio (HR) 0·68, 95 per cent c.i. 0·49 to 0·93; P = 0·016), and 5-year disease-free survival rates of 44·9 and 36·1 per cent (HR 0·68, 0·50 to 0·93; P = 0·017).

CONCLUSION:

NCT was associated with better overall and disease-free survival in patients with stage I or II oesophageal cancer, without increasing postoperative morbidity.

©PubMed Central


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