Abstract
BackgroundReports have shown that neoadjuvant concurrent chemoradiotherapy (nCRT) increases the R0 resection rate for patients with Siewert type II or III adenocarcinoma of the gastroesophageal junction (AEG). However, the long-term efficacy of nCRT for AEG patients remains unclear. In this multicenter study, we investigated the long-term results of AEG patients treated with nCRT.MethodsA total of 149 patients with potentially resectable advanced AEG (T3/4, Nany, M0) were randomly divided into two groups: the nCRT-treated group (treated group) (n = 76) and the surgery group (control group) (n = 73). The primary endpoint was disease-free survival (DFS), and the secondary outcome indexes included the R0 resection rate, HER-2 expression, tumor regression grade (TRG), objective response rate (ORR), disease control rate (DCR), overall survival (OS), and adverse events.ResultsIn the treated group, the overall therapeutic efficacy rate was 40.8%, and the pathological complete response (pCR) rate was 16.9%. The rates of patients who underwent R0 resection in the treated and control groups were 97.0% and 87.7%, respectively (p < 0.05). The toxic effects were mainly graded 1–2 in the treated group. The median DFS times in the treated and control groups were 33 and 27 months, respectively (p = 0.08), whereas the median OS times were 39 and 30 months, respectively (p = 0.01). The median DFS times of patients with positive and negative HER-2 expression in the treated group were 13 and 43 months, respectively (p = 0.01), and the median OS times were 27 and 41 months, respectively (p = 0.01).ConclusionSurgery after nCRT improved the efficacy of treatment for AEG patients and thus provided a better prognosis.Clinical Trial RegistrationThe trial is registered with ClinicalTrials.gov (number NCT01962246).
Highlights
In recent years, the incidence of adenocarcinoma of the esophagogastric junction (AEG) has been increasing worldwide [1,2,3]
The patient inclusion criteria for this study consisted of the following: [1] gastroscopy- and computed tomography (CT)confirmed Siewert type II or III AEG with a long diameter of the primary tumor ≤8 cm prior to surgery; [2] American Joint Committee on Cancer (AJCC) 2010 classification of progressive gastric cancer before surgery (T3/4, Nany, M0) with no evidence of metastatic lesions in the liver, lung, brain, bone or other organs; [3] no prior antitumor therapy; [4] no contradictions to chemotherapy or surgery; [5] a Karnofsky Performance Scale (KPS) score >60 and an Eastern Cooperative Oncology Group (ECOG) score 0–2; and [6] informed consent obtained before enrollment in the study
A total of 149 patients with AEG who were admitted to the Fourth Hospital of Hebei Medical University between August 2012 and January 2016 were enrolled in this study
Summary
The incidence of adenocarcinoma of the esophagogastric junction (AEG) has been increasing worldwide [1,2,3]. Most clinicians believe that appropriate perioperative treatments should be used for AEG, and regarding this topic, an increasing number of researchers are trying preoperative concurrent chemoradiotherapy for AEG [4, 5]. Siewert types II and III are representative of AEG, and the effect of neoadjuvant chemoradiotherapy (nCRT) is currently a research hotspot. The “Preoperative Concurrent Chemoradiotherapy for Potentially Resectable Adenocarcinoma of Esophagogastric Junction (NCT01962246)” trial conducted by our center has reported mid-term results [7] and verified a satisfactory surgical R0 resection rate and tolerable safety. Reports have shown that neoadjuvant concurrent chemoradiotherapy (nCRT) increases the R0 resection rate for patients with Siewert type II or III adenocarcinoma of the gastroesophageal junction (AEG). The long-term efficacy of nCRT for AEG patients remains unclear. We investigated the long-term results of AEG patients treated with nCRT
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