Objective: 

To compare overall (OS) and recurrence-free survival (RFS) in esophageal adenocarcinoma patients with a pathologically complete response (pCR) following neoadjuvant chemotherapy (nCT) or neoadjuvant chemoradiotherapy (nCRT).

Background: 

In the absence of survival differences in several prior studies comparing nCT with nCRT, the higher rate of pCR after nCRT has been suggested as reason to prefer this modality over nCT.

Methods: 

An international cohort study included data from 8 high-volume centers. Inclusion criteria was patients with esophageal adenocarcinoma, between 2008 and 2018, who had a pCR after nCT or nCRT. Univariate analysis was used to compare demographic factors, and Kaplan-Meier survival analysis used to compare 5-year OS and RFS between groups.

Results: 

In all, 465 patients with pCR following neoadjuvant treatment were included; 132 received nCT and 333 received nCRT. There was no statistically significant difference in 5-year OS between groups (78.8% (nCT) vs 65.5% (nCRT), P=0.099), with a similar result demonstrated in multivariate analysis (HR=1.19, 95% CI 0.77–1.84). 5-year RFS was significantly reduced in patients with a pCR following neoadjuvant chemoradiotherapy (75.3% (nCRT) vs 87.1% (nCT), P=0.026). Multivariate analysis confirmed nCRT was associated with a poorer 5-year RFS (HR=1.70, 95% CI 1.22–2.99). nCRT associated with a significantly greater prevalence of 5-year distant recurrence (odds ratio=2.50, 95% CI 1.25–4.99)

Conclusions: 

The results of this international cohort study show that the prognosis of pCR following different neoadjuvant regimes differs, bringing into question the validity of this measure as an oncological surrogate when comparing neoadjuvant treatment schemes for esophageal adenocarcinoma.

中文翻译：

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一项关于手术治疗食管腺癌新辅助化疗与放化疗后病理完全缓解相关预后的国际队列研究

客观的： 

比较新辅助化疗 (nCT) 或新辅助放化疗 (nCRT) 后病理完全缓解 (pCR) 的食管腺癌患者的总生存期 (OS) 和无复发生存期 (RFS)。

背景： 

在之前的几项比较 nCT 与 nCRT 的研究中没有生存差异的情况下，nCRT 后 pCR 率较高被认为是首选这种方式而不是 nCT 的原因。

方法： 

一项国际队列研究包括来自 8 个高容量中心的数据。纳入标准为 2008 年至 2018 年期间在 nCT 或 nCRT 后获得 pCR 的食管腺癌患者。单变量分析用于比较人口统计学因素，Kaplan-Meier 生存分析用于比较组间的 5 年 OS 和 RFS。

结果： 

总共纳入了 465 名新辅助治疗后 pCR 患者；132 人接受了 nCT，333 人接受了 nCRT。组间 5 年 OS 无统计学差异（78.8% (nCT) vs 65.5% (nCRT)，P = 0.099），多变量分析结果相似（HR = 1.19, 95% CI 0.77–1.84 ）。新辅助放化疗后 pCR 患者的 5 年 RFS 显着降低（75.3% (nCRT) vs 87.1% (nCT)，P = 0.026）。多变量分析证实 nCRT 与较差的 5 年 RFS 相关（HR=1.70，95% CI 1.22-2.99）。nCRT 与显着更高的 5 年远处复发率相关（优势比 = 2.50, 95% CI 1.25–4.99）

结论： 

这项国际队列研究的结果表明，不同新辅助方案后 pCR 的预后不同，在比较食管腺癌的新辅助治疗方案时，该措施作为肿瘤学替代指标的有效性受到质疑。