Tumor Stage After Neoadjuvant Chemotherapy Determines Survival After Surgery for Adenocarcinoma of the Esophagus and Esophagogastric Junction

被引:209
作者
Davies, Andrew R. [1 ,2 ,5 ]
Gossage, James A. [1 ,2 ,5 ]
Zylstra, Janine [1 ,2 ,5 ]
Mattsson, Fredrik [5 ]
Lagergren, Jesper [1 ,2 ,5 ]
Maisey, Nick [1 ]
Smyth, Elizabeth C. [3 ,4 ]
Cunningham, David [3 ,4 ]
Allum, William H. [3 ]
Mason, Robert C. [1 ,2 ,5 ]
机构
[1] St Thomas Hosp, London SE1 7EH, England
[2] Kings Coll London, London WC2R 2LS, England
[3] Royal Marsden Hosp, London, England
[4] Inst Canc Res, Biomed Res Ctr, London SW3 6JB, England
[5] Karolinska Inst, Stockholm, Sweden
关键词
LYMPH-NODES; PREOPERATIVE CHEMORADIOTHERAPY; PERIOPERATIVE CHEMOTHERAPY; SURGICAL RESECTION; CANCER; MICROMETASTASIS; ESOPHAGECTOMY; RECURRENCE; CARCINOMA; DISEASE;
D O I
10.1200/JCO.2014.55.9070
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Purpose Neoadjuvant chemotherapy is established in the management of most resectable esophageal and esophagogastric junction adenocarcinomas. However, assessing the downstaging effects of chemotherapy and predicting response to treatment remain challenging, and the relative importance of tumor stage before and after chemotherapy is debatable. Methods We analyzed consecutive resections for esophageal or esophagogastric junction adenocarcinomas performed at two high-volume cancer centers in London between 2000 and 2010. After standard investigations and multidisciplinary team consensus, all patients were allocated a clinical tumor stage before treatment, which was compared with pathologic stage after surgical resection. Survival analysis was conducted using Kaplan-Meier analysis and Cox regression analysis. Results Among 584 included patients, 400 patients (68%) received neoadjuvant chemotherapy. Patients with downstaged tumors after neoadjuvant chemotherapy experienced improved survival compared with patients without response (P < .001), and such downstaging (hazard ratio, 0.43; 95% CI, 0.31 to 0.59) was the strongest independent predictor of survival after adjusting for patient age, tumor grade, clinical tumor stage, lymphovascular invasion, resection margin status, and surgical resection type. Patients downstaged by chemotherapy, compared with patients with no response, experienced lower rates of local recurrence (6% v 13%, respectively; P = .030) and systemic recurrence (19% v 29%, respectively; P = .027) and improved Mandard tumor regression scores (P = .001). Survival was strongly dictated by stage after neoadjuvant chemotherapy, rather than clinical stage at presentation. Conclusion The stage of esophageal or esophagogastric junction adenocarcinoma after neoadjuvant chemotherapy determines prognosis rather than the clinical stage before neoadjuvant chemotherapy, indicating the importance of focusing on postchemotherapy staging to more accurately predict outcome and eligibility for surgery. Patients who are downstaged by neoadjuvant chemotherapy benefit from reduced rates of local and systemic recurrence. (C) 2014 by American Society of Clinical Oncology
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页码:2983 / +
页数:9
相关论文
共 24 条
[1]  
Bancewicz J, 2002, LANCET, V359, P1727
[2]   Bone marrow-disseminated tumor cells in patients with carcinoma of the esophagus or cardia [J].
Bonavina, L ;
Soligo, D ;
Quirici, N ;
Bossolasco, P ;
Cesana, B ;
Deliliers, GL ;
Peracchia, A .
SURGERY, 2001, 129 (01) :15-22
[3]   Analysis of micrometastatic disease in histologically negative lymph nodes of patients with adenocarcinoma of the distal esophagus or gastric cardia [J].
Buskens, C. J. ;
Ten Kate, F. J. W. ;
Obertop, H. ;
Izbicki, J. R. ;
van Lanschot, J. J. B. .
DISEASES OF THE ESOPHAGUS, 2008, 21 (06) :488-495
[4]   Capecitabine and oxaliplatin for advanced esophagogastric cancer [J].
Cunningham, David ;
Starling, Naureen ;
Rao, Sheela ;
Iveson, Timothy ;
Nicolson, Marianne ;
Coxon, Fareeda ;
Middleton, Gary ;
Daniel, Francis ;
Oates, Jacqueline ;
Norman, Andrew Richard .
NEW ENGLAND JOURNAL OF MEDICINE, 2008, 358 (01) :36-46
[5]   Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer [J].
Cunningham, David ;
Allum, William H. ;
Stenning, Sally P. ;
Thompson, Jeremy N. ;
Van de Velde, Cornelis J. H. ;
Nicolson, Marianne ;
Scarffe, J. Howard ;
Lofts, Fiona J. ;
Falk, Stephen J. ;
Iveson, Timothy J. ;
Smith, David B. ;
Langley, Ruth E. ;
Verma, Monica ;
Weeden, Simon ;
Chua, Yu Jo .
NEW ENGLAND JOURNAL OF MEDICINE, 2006, 355 (01) :11-20
[6]   Surgical resection strategy and the influence of radicality on outcomes in oesophageal cancer [J].
Davies, A. R. ;
Sandhu, H. ;
Pillai, A. ;
Sinha, P. ;
Mattsson, F. ;
Forshaw, M. J. ;
Gossage, J. A. ;
Lagergren, J. ;
Allum, W. H. ;
Mason, R. C. .
BRITISH JOURNAL OF SURGERY, 2014, 101 (05) :511-517
[7]   Factors associated with early recurrence and death after esophagectomy for cancer [J].
Davies, Andrew R. ;
Pillai, Andrew ;
Sinha, Pranab ;
Sandhu, Harinderjeet ;
Adeniran, Amina ;
Mattsson, Fredrik ;
Choudhury, Asif ;
Forshaw, Matthew J. ;
Gossage, James A. ;
Lagergren, Jesper ;
Allum, William H. ;
Mason, Robert C. .
JOURNAL OF SURGICAL ONCOLOGY, 2014, 109 (05) :459-464
[8]   Prognostic value of immunohistochemically identifiable tumor cells in lymph nodes of patients with completely resected esophageal cancer [J].
Izbicki, JR ;
Hosch, SB ;
Pichlmeier, U ;
Rehders, A ;
Busch, C ;
Niendorf, A ;
Passlick, B ;
Broelsch, CE ;
Pantel, K .
NEW ENGLAND JOURNAL OF MEDICINE, 1997, 337 (17) :1188-1194
[9]   Lymph node micrometastasis: A predictor of early tumor relapse after complete resection of histologically node-negative esophageal cancer [J].
Li, Shu-Hai ;
Wang, Zhou ;
Liu, Xiang-Yan ;
Liu, Fan-Ying ;
Sun, Zhao-Yi ;
Xue, Han .
SURGERY TODAY, 2007, 37 (12) :1047-1052
[10]  
MANDARD AM, 1994, CANCER, V73, P2680, DOI 10.1002/1097-0142(19940601)73:11<2680::AID-CNCR2820731105>3.0.CO