Real-world outcomes of perioperative chemotherapy versus neoadjuvant chemoradiation in patients with esophageal or gastroesophageal junction adenocarcinoma assessed using the NCDB.

Abstract

e16085 Background: In the CROSS trial, chemoradiation therapy (CRT) prior to esophagectomy resulted in a marginal survival benefit in patients with esophageal or gastroesophageal junction (GEJ) adenocarcinoma and a larger benefit in patients with esophageal squamous cell carcinoma. In the FLOT4 trial, chemotherapy plus surgery followed by more chemotherapy showed a significant survival benefit in patients with locally advanced GEJ cancers without the use of radiation. Therefore, we wished to examine whether the addition of preoperative radiation to chemotherapy and esophagectomy in patients with locally advanced esophageal or GEJ adenocarcinomas yielded benefits using real-world data. Methods: We queried the National Cancer Database (NCDB) for adult patients with stage II–IV adenocarcinoma of the non-cervical esophagus or GEJ/ gastric cardia, who were diagnosed with invasive adenocarcinoma between 2006 to 2021 and who had esophagectomy as part of multi-disciplinary treatment (n = 15677). The patients were divided into 2 groups. The CRT group comprised patients who received preoperative chemotherapy plus radiation therapy followed by esophagectomy, and the POC (perioperative chemotherapy) group comprised patients who received chemotherapy followed by esophagectomy followed by adjuvant chemotherapy. Comparisons were made after propensity-score matching (PSM) (2:1) for clinical stage, age (> 60 and ≤60), sex, and Charlson-Deyo score. Chi-square, Wilcoxon, and Kaplan-Meier tests were applied. Results: After PSM, the CRT group contained 608 patients, and the POC group contained 304 patients. Male patients accounted for 86.5% of patients in each group, and median patient age was 61 years (IQR 13). Stage distribution was similar between the PSM groups (stage II, 23.4%; stage III, 56.2%; and stage IV 20.4%). Median overall survival was significantly better in the POC group as compared with the CRT group (POC 56.7 months, 95% CI 44.6-69.4 vs CRT 39.7 months, 95% CI: 33.5-48.3 p = 0.002). Conclusions: Perioperative chemotherapy plus surgery leads to better outcomes for patients with esophageal or GEJ adenocarcinoma as compared with chemoradiation therapy plus surgery. In fact, the addition of preoperative radiation negatively impacted survival in our analysis of real-world data from a large database of patients treated in the United States. Larger randomized control trials need to validate these results.