Adjuvant Chemotherapy vs Observation After Preoperative Chemoradiotherapy and Resection in Gastroesophageal Cancer
In a propensity score–matched analysis reported in JAMA Oncology, Mokdad et al found that adjuvant chemotherapy had a survival benefit vs observation after preoperative chemoradiotherapy and resection in patients with locally advanced gastroesophageal cancer.
Study Details
The study included 10,086 adult patients in the National Cancer Database who were diagnosed between 2006 and 2013 with clinical stage T1, N1–3, M0 or T2–4, N0–3, M0 adenocarcinoma of the distal esophagus or gastric cardia and received preoperative chemoradiotherapy and curative-intent resection. Patients receiving adjuvant chemotherapy were matched by propensity score with patients undergoing postoperative observation.
Patient Characteristics
Among all patients (88% male, mean age = 61 years), 9,272 underwent postoperative observation and 814 received adjuvant chemotherapy. Patients receiving adjuvant chemotherapy were younger (31% vs 21% aged 18–54 years, P < .001), more likely to have advanced disease (ypT3/4 for 62% vs 46%, P < .001; ypN+ for 72% vs 39%, P < .001), and had shorter postoperative inpatient stays (> 2 weeks for 13% vs 20%, P < .001).
Overall Survival
A total of 732 patients in the adjuvant chemotherapy group were matched by propensity score with 3,660 in the observation group. Median overall survival was 40 months in the adjuvant chemotherapy group vs 34 months in the observation group (hazard ratio = 0.79, P < .001), with a survival benefit of adjuvant chemotherapy being observed in most patient subgroups. Overall survival was 94% vs 88% at 1 year, 54% vs 47% at 3 years, and 38% vs 34% at 5 years, respectively.
The investigators concluded: “For patients with locally advanced gastroesophageal adenocarcinoma treated with preoperative chemoradiotherapy and resection, adjuvant chemotherapy was associated with improved overall survival. Our findings have important implications for the postoperative treatment of this patient group for which few data are available.”
Matthew R. Porembka, MD, of The University of Texas Southwestern Medical Center, is the corresponding author of the JAMA Oncology article.
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