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Tumor stage after neoadjuvant chemotherapy predicted post-surgery survival in esophageal adenocarcinoma
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Tumor stage after neoadjuvant chemotherapy determined how long patients with esophageal and esophagogastric junction adenocarcinoma survived after surgery, according to study results.
Most patients with resectable esophageal or esophagogastric junction adenocarcinomas undergo neoadjuvant chemotherapy. However, efforts to predict response to treatment remain challenging, and the importance of tumor stage prior to and after chemotherapy has not been established, according to background information provided by researchers.
Andrew R. Davies, MD, of the department of surgery at St. Thomas’ Hospital in London, and colleagues assessed 400 consecutive resections for esophageal or esophagogastric junction adenocarcinomas performed between 2000 and 2010. The patients’ mean age was 63 years and 86% were male.
Researchers reported more favorable survival outcomes among patients with downstaged tumors after neoadjuvant chemotherapy compared with patients who did not demonstrate a response (P<.001).
After the researchers adjusted for age, tumor grade, clinical tumor stage, lymphovascular invasion, resection margin status and surgical resection type, tumor downstaging (HR=0.43; 95% CI, 0.31-0.59) was the strongest independent predictor of survival.
Additionally, patients whose tumors were downstaged after chemotherapy experienced lower rates of local recurrence (P=.030) and systemic recurrence (P=.027), as well as improved Mandard tumor regression scores (P<.001).
The findings suggest tumor stage after neoadjuvant chemotherapy rather than clinical stage determines prognosis, the researchers concluded.
“The importance of tumor downstaging in terms of survival, complete surgical resection and recurrence pattern has significant clinical implications,” Davies and colleagues wrote. “The demonstration of a systemic effect of chemotherapy is particularly poignant at a time when much controversy exists regarding the optimal neoadjuvant treatment strategy for these cancers. Improving the assessment of response to neoadjuvant chemotherapy is critical if we are to successfully adopt a policy of individualized therapy.”
Disclosure: The researchers report honoraria and research funding from Amgen, Astellas, AstraZeneca, Celgene, Eli Lilly, Merck, Nestle, Novartis, Roche and Sanofi-Aventis.
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