Abstract
ObjectiveTo analyze the effect of neoadjuvant radiotherapy (nRT) on prognosis in patients with locoregional Siewert type II gastroesophageal junction adenocarcinoma (GEA).MethodAll patients pathologically diagnosed as Siewert type II GEA between 2004 and 2015 were retrieved from the Surveillance, Epidemiology and Final Results (SEER) database. We analyzed the impact of different treatment regimens on the prognosis in each stage. Survival analysis was performed by Kaplan-Meier (K-M) method. Multivariate Cox model and propensity score matching was further used to verify the results.Results4,160 patients were included in this study. The efficacy of nRT was superior to that of adjuvant radiotherapy (aRT) (p = 0.048), which was the same as that of surgery combined with chemotherapy (p = 0.836), but inferior to the overall survival (OS) of surgical treatment alone (p<0.001) in T1-2N0M0 patients. Patients receiving nRT had distinctly better survival than those receiving surgical treatment alone (p = 0.008), but had similar survival compared with patients treated with aRT (p = 0.989) or surgery combined with chemotherapy (p = 0.205) in the T3N0/T1-3N+M0 subgroup. The efficacy of nRT is clearly stronger than that of surgical therapy alone (p<0.001), surgery combined with chemotherapy (p<0.001), and aRT (p = 0.008) in patients with T4 stage. The survival analysis results were consistent before and after propensity score matching.ConclusionIn these carefully selected patients, the present study made the following recommendations: nRT can improve the prognosis of patients with T3N0M0/T1-3N+M0 and T4 Siewert type II GEA, and it seems to be a better treatment for T4 patients. Surgery alone seems to be sufficient, and nRT is not conducive to prolonging the survival of Siewert II GEA patients with T1-2N0M0 stage. Of course, further prospective trials are needed to verify this conclusion.
Highlights
It was estimated that about 18,000 new cases and 13,000 deaths from esophageal cancer occur in the United States in 2020 [1]
Patients receiving neoadjuvant radiotherapy (nRT) had distinctly better survival than those receiving surgical treatment alone (p = 0.008), but had similar survival compared with patients treated with adjuvant radiotherapy (aRT) (p = 0.989) or surgery combined with chemotherapy (p = 0.205) in the T3N0/T1-3N+M0 subgroup
The survival analysis results were consistent before and after propensity score matching. In these carefully selected patients, the present study made the following recommendations: nRT can improve the prognosis of patients with T3N0M0/T1-3N+M0 and T4 Siewert type II
Summary
It was estimated that about 18,000 new cases and 13,000 deaths from esophageal cancer occur in the United States in 2020 [1]. Siewert type I (distal esophageal adenocarcinoma) originates from the specialized intestinal area of the esophagus (such as Barrett’s esophagus), which can infiltrate the esophagusgastric junction from above(located 1–5 cm above the GEJ); Siewert type II (cardia cancer) originates from the junction of the esophagus and stomach(located 1cm above the GEJ to 2cm below); Siewert type III (subcardial gastric carcinoma) refers to the esophagogastric junction and the distal esophagus are infiltrated from the bottom inward(located 2–5 cm below the GEJ) [4]. The latest TNM staging system (8th edition) classifies Siewert type II as esophageal cancer, it is difficult to determine whether the origin is gastric cancer or esophageal cancer, so the optimal treatment has been controversial
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