Abstract Background Perioperative chemotherapy is widely used in the treatment of oesophagogastric adenocarcinoma (OGAC) with a substantial survival benefit over surgery alone. However, the postoperative part of these regimens is given in less than half of patients, reflecting uncertainty among clinicians about its benefit and poor postoperative patient fitness. This study estimated the effect of postoperative chemotherapy after surgery for OGAC using a large population-based data set. Methods Patients with adenocarcinoma of the oesophagus, gastro-oesophageal junction or stomach diagnosed between 2012 and 2018, who underwent preoperative chemotherapy followed by surgery, were identified from a national-level audit in England and Wales. Postoperative therapy was defined as the receipt of systemic chemotherapy within 90 days of surgery. The effectiveness of postoperative chemotherapy compared with observation was estimated using inverse propensity treatment weighting. Results Postoperative chemotherapy was given to 1593 of 4139 patients (38.5 per cent) included in the study. Almost all patients received platinum-based triplet regimens (4004 patients, 96.7 per cent), with FLOT used in 3.3 per cent. Patients who received postoperative chemotherapy were younger, with a lower ASA grade, and were less likely to have surgical complications, with similar tumour characteristics. After weighting, the median survival time after postoperative chemotherapy was 62.7 months compared with 50.4 months without chemotherapy (hazard ratio 0.84, 95 per cent c.i. 0.77 to 0.94; P = 0.001). Conclusion This study has shown that postoperative chemotherapy improves overall survival in patients with OGAC treated with preoperative chemotherapy and surgery.

中文翻译：

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食管胃腺癌术前化疗和手术后化疗对生存的影响


摘要背景围手术期化疗广泛用于食管胃腺癌（OGAC）的治疗，与单纯手术相比，具有显着的生存获益。然而，只有不到一半的患者接受了这些方案的术后部分，这反映出临床医生对其益处的不确定性以及术后患者健康状况不佳。本研究使用基于人群的大型数据集评估了 OGAC 术后化疗的效果。方法英格兰和威尔士的国家级审计确定了 2012 年至 2018 年间诊断出的食管、胃食管交界处或胃腺癌患者，这些患者接受了术前化疗，随后进行了手术。术后治疗定义为手术后 90 天内接受全身化疗。使用逆倾向治疗权重来评估术后化疗与观察相比的有效性。结果 在该研究中，4139 名患者中有 1593 名（38.5%）接受了术后化疗。几乎所有患者都接受了基于铂类的三联疗法（4004 名患者，96.7%），其中 3.3% 使用了 FLOT。接受术后化疗的患者年龄较小，ASA分级较低，发生手术并发症的可能性较小，肿瘤特征相似。加权后，术后化疗后的中位生存时间为 62.7 个月，而未化疗的中位生存时间为 50.4 个月（风险比 0.84，95% CI 0.77 至 0.94；P = 0.001）。 结论这项研究表明，术后化疗可提高接受术前化疗和手术治疗的 OGAC 患者的总体生存率。