Optimal multimodality treatment followed by surgical resection results in cure for less than half of patients with operable adenocarcinoma of the lower esophagus or gastroesophageal junction. This is true whether the adjunctive therapy is neoadjuvant chemotherapy, perioperative chemotherapy, or neoadjuvant chemoradiotherapy. Therefore, it is reasonable to question whether additional treatment beyond current standards of care might increase the proportion of patients cured. In this issue of JAMA Oncology, Mokdad and colleagues,¹ in a propensity score–matched analysis based on a large National Cancer Database cohort, examine the effects of adjuvant chemotherapy following chemoradiotherapy and surgery for resectable gastroesophageal adenocarcinoma. They found that patients treated with adjuvant chemotherapy had improved overall survival compared with those who did not receive adjuvant treatment (median overall survival, 40 vs 34 months; hazard ratio, 0.79; 95% CI, 0.72-0.88; P < .001). Based on these findings, a randomized clinical trial of adjuvant chemotherapy vs observation following neoadjuvant chemoradiotherapy and surgical resection is proposed to provide a definitive answer to this question.

手术切除后的最佳多模式治疗可治愈不到一半的食管下段或胃食管交界处可手术腺癌患者。无论辅助治疗是新辅助化疗、围手术期化疗还是新辅助放化疗，都是如此。因此，质疑超出当前护理标准的额外治疗是否会增加治愈患者的比例是合理的。在本期JAMA Oncology中，Mokdad 及其同事，¹在基于大型国家癌症数据库队列的倾向评分匹配分析中，检查了可切除胃食管腺癌放化疗和手术后辅助化疗的效果。他们发现，与未接受辅助治疗的患者相比，接受辅助化疗的患者总生存期有所提高（中位总生存期，40 个月 vs 34 个月；风险比，0.79；95% CI，0.72-0.88；P  < .001）。基于这些发现，提出了一项新辅助放化疗和手术切除后辅助化疗与观察的随机临床试验，为这个问题提供明确的答案。