Pharmacy Department, Hospital Universitario Central de Asturias, Avenida Roma s/n, 33011, Oviedo, Spain.
Medical Oncology Department, Hospital Universitario Central de Asturias, ISPA, Oviedo, Spain.
Gastric Cancer. 2021 Jul;24(4):926-936. doi: 10.1007/s10120-021-01169-6. Epub 2021 Mar 2.
Advanced esophageal adenocarcinoma (EAC) is generally treated similarly to advanced gastroesophageal junction (GEJ-AC) and gastric (GAC) adenocarcinomas, although GAC clinical trials rarely include EAC. This work sought to compare clinical characteristics and treatment outcomes of advanced EAC with those of GEJ-AC and GAC and examine prognostic factors.
Participants comprised patients with advanced EAC, intestinal GEJ-AC, and GAC treated with platin and fluoropyrimidine (plus trastuzumab when HER2 status was positive). Overall and progression-free survival were estimated using the Kaplan-Meier method. Cox proportional hazards regression gauged the prognostic value of the AGAMENON model.
Between 2008 and 2019, 971 participants from the AGAMENON-SEOM registry were recruited at 35 centers. The sample included 67.3% GAC, 13.3% GEJ-AC, and 19.4% EAC. Pulmonary metastases were most common in EAC and peritoneal metastases in GAC. Median PFS and OS were 7.7 (95% CI 7.3-8.0) and 13.9 months (12.9-14.7). There was no difference in PFS or OS between HER2- and HER2+ tumors from the three locations (p > 0.05). Five covariates were found to be prognostic for the entire sample: ECOG-PS, histological grade, number of metastatic sites, NLR, and HER2+ tumors treated with trastuzumab. In EAC, the same variables were prognostic except for grade. The favorable prognosis for HER2+ cancers treated with trastuzumab was homogenous for all three subgroups (p = 0.351) and, after adjusting for the remaining covariates, no evidence supported primary tumor localization as a prognostic factor (p = 0.331).
Our study supports the hypothesis that EAC exhibits clinicopathological characteristics, prognostic factors, and treatment outcomes comparable to intestinal GEJ-AC and GAC.
高级食管腺癌（EAC）的治疗通常与高级胃食管交界处（GEJ-AC）和胃腺癌（GAC）相似，尽管 GAC 临床试验很少包括 EAC。这项工作旨在比较晚期 EAC 与 GEJ-AC 和 GAC 的临床特征和治疗结果，并探讨预后因素。
参与者包括接受铂类和氟嘧啶治疗的晚期 EAC、肠型 GEJ-AC 和 GAC 患者（HER2 状态阳性时加用曲妥珠单抗）。使用 Kaplan-Meier 法估计总生存期和无进展生存期。Cox 比例风险回归评估 AGAMENON 模型的预后价值。
2008 年至 2019 年，来自 AGAMENON-SEOM 登记处的 971 名参与者在 35 个中心被招募。样本包括 67.3%的 GAC、13.3%的 GEJ-AC 和 19.4%的 EAC。EAC 中最常见的肺转移，GAC 中最常见的腹膜转移。中位 PFS 和 OS 分别为 7.7（95%CI 7.3-8.0）和 13.9 个月（12.9-14.7）。来自三个部位的 HER2-和 HER2+肿瘤的 PFS 或 OS 无差异（p>0.05）。发现 5 个协变量对整个样本具有预后意义：ECOG-PS、组织学分级、转移部位数量、NLR 和接受曲妥珠单抗治疗的 HER2+肿瘤。在 EAC 中，除了分级外，相同的变量具有预后意义。接受曲妥珠单抗治疗的 HER2+癌症的良好预后在所有三个亚组中均一致（p=0.351），并且在调整其余协变量后，没有证据支持原发肿瘤定位是一个预后因素（p=0.331）。
我们的研究支持以下假设，即 EAC 表现出与肠型 GEJ-AC 和 GAC 相似的临床病理特征、预后因素和治疗结果。
