Abstract Background Trials typically group cancers of the gastro-oesophageal junction (GOJ) with oesophageal or gastric cancer when studying neoadjuvant chemoradiation and perioperative chemotherapy, so the results may not be fully applicable to GOJ cancer. Because optimal neoadjuvant treatment for GOJ cancer remains controversial, outcomes with neoadjuvant chemoradiation versus chemotherapy for locally advanced GOJ adenocarcinoma were compared retrospectively. Methods Data were collected from all patients who underwent neoadjuvant treatment followed by surgery for adenocarcinoma located at the GOJ at a single high-volume institution between 2002 and 2017. Postoperative major complications and mortality were compared between groups using Fisher’s exact test. Overall survival (OS) and disease-free survival (DFS) were assessed by log rank test and multivariable Cox regression analyses. Cumulative incidence functions were used to estimate recurrence, and groups were compared using Gray’s test. Results Of 775 patients, 650 had neoadjuvant chemoradiation and 125 had chemotherapy. These groups were comparable in terms of clinical tumour and lymph node categories, although the chemoradiation group had greater proportions of white men, complete pathological response to chemotherapy, and smaller proportions of diffuse cancer, poor differentiation, and neurovascular invasion. Postoperative major complications (20.0 versus 17.6 per cent) and 30-day mortality (1.7 versus 1.6 per cent) were not significantly different between the chemoradiation and chemotherapy groups. After adjustment, type of therapy (chemoradiation versus chemotherapy) was not significantly associated with OS (hazard ratio (HR) 1.26, 95 per cent c.i. 0.96 to 1.67) or DFS (HR 1.27, 0.98 to 1.64). Type of recurrence (local, regional, or distant) did not differ after neoadjuvant chemoradiation versus chemotherapy. Conclusion In patients undergoing surgical resection for locally advanced adenocarcinoma of the GOJ, OS and DFS did not differ significantly between patients who had neoadjuvant chemoradiation compared with chemotherapy.

中文翻译：

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局部晚期胃食管交界腺癌新辅助放化疗或化疗后的预后

摘要 背景在研究新辅助放化疗和围手术期化疗时，试验通常将胃食管结合部 (GOJ) 癌症与食管癌或胃癌分组，因此结果可能并不完全适用于 GOJ 癌症。由于 GOJ 癌的最佳新辅助治疗仍存在争议，因此对局部晚期 GOJ 腺癌的新辅助放化疗与化疗的结果进行了回顾性比较。 方法数据收集自 2002 年至 2017 年间在单一大容量机构接受新辅助治疗并随后接受位于 GOJ 的腺癌手术的所有患者。使用 Fisher 精确检验比较各组之间的术后主要并发症和死亡率。通过对数秩检验和多变量 Cox 回归分析评估总生存期 (OS) 和无病生存期 (DFS)。累积发生率函数用于估计复发，并使用格雷检验进行组间比较。 结果在 775 名患者中，650 名接受了新辅助放化疗，125 名接受了化疗。这些组在临床肿瘤和淋巴结类别方面具有可比性，尽管放化疗组白人男性比例较高，对化疗有完全病理反应，而弥漫性癌、分化差和神经血管侵犯的比例较小。放化疗组和化疗组之间的术后主要并发症（20% vs 17.6%）和 30 天死亡率（1.7% vs 1.6%）没有显着差异。调整后，治疗类型（放化疗与化疗）与 OS（风险比 (HR) 1.26，95% CI 0.96 至 1.67）或 DFS（HR 1.27，0.98 至 1.64）没有显着相关。新辅助放化疗与化疗后的复发类型（局部、区域或远处）没有差异。 结论在因局部晚期 GOJ 腺癌接受手术切除的患者中，接受新辅助放化疗的患者与接受化疗的患者之间的 OS 和 DFS 没有显着差异。