485. MATTHEW EFFECT OF NEOADJUVANT THERAPY IN ESOPHAGEAL CANCER

Abstract

Abstract Carcinoma. Background Neoadjuvant therapy benefits long-term survival to patients with locally advanced Esophageal Squamous Cell Carcinoma (ESCC). If the survival benefit brought by neoadjuvant therapy is considered as a positive improvement for majority patients, outweighing the negative harms, it means that some patients will experience a reduction in survival due to the negative harms, just as the Matthew effect. This study focuses on these failures of Matthew effect who may not benefit from neoadjuvant therapy and explores the specific recurrent patterns. Method A total of 457 recurrent ESCC patients undergoing curative esophagectomy were enrolled, including 140 patients treated with neoadjuvant therapy. The median progression time (MPT) were 24.3 months. Tumor recurrences or metastases occurring before MPT were defined as treatment failure. We retrospectively investigated the patterns of recurrence and the prognosis in patients with neoadjuvant therapy. Results Among recurrent patients, locoregional recurrence, lung and bone metastases were the most common recurrence sites. The median progression time to the first recurrence was 24.3 months. The locoregional recurrence rate of neoadjuvant group was lower than that of none-adjuvant group (46% vs 60.2%), while the liver and brain metastasis rates was higher (16% vs 7.5% and 8.1% vs 3.3% respectively). Kaplan–Meier analysis showed unsatisfactory prognosis for neoadjuvant therapy failures than those without neoadjuvant therapy. Moreover, for non-neoadjuvant ESCC, shorter overall survival was found in distant recurrence failures than those with locoregional recurrence, while the different recurrence patterns shared similar prognosis for neoadjuvant therapy failures. Conclusion For treatment failure patients with early progression, neoadjuvant therapy has an advantage in controlling local recurrence, but this positive improvement does not transform into survival benefits, indicating Matthew effect of neoadjuvant therapy in ESCC.