Pape Marieke, Vissers Pauline A J, Beerepoot Laurens V, van Berge Henegouwen Mark I, Lagarde Sjoerd M, Mook Stella, Moehler Markus, van Laarhoven Hanneke W M, Verhoeven Rob H A
Department of Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), The Netherlands.
Department of Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.
Ther Adv Med Oncol. 2022 Feb 26;14:17588359221075495. doi: 10.1177/17588359221075495. eCollection 2022.
Results of CheckMate 577 show an improved disease-free survival for patients with resected esophageal or gastroesophageal junction cancer treated with adjuvant nivolumab compared with placebo (22.4 11.0 months). Population-based data can provide insights in outcomes from clinical practice. The aim of our study was to investigate disease-free and overall survival in a nationwide population aligned with the inclusion criteria of CheckMate 577.
Resected patients with stage II/III esophageal or gastroesophageal junction cancer (2015-2016) treated with neoadjuvant chemoradiotherapy were selected from the Netherlands Cancer Registry. Patients with cervical esophageal cancer, irradical resection, or complete pathological response were excluded. Disease-free and overall survival were assessed from 12 weeks after resection using Kaplan-Meier methods. In addition, to adjust for differences in characteristics between CheckMate 577 and our population-based cohort, a matching-adjusted indirect comparison was performed for pathological lymph node status and pathological tumor status.
We identified 634 patients. Sixty percent of patients were diagnosed with recurrence or were deceased at the end of follow-up. Median disease-free survival was 19.7 months and median overall survival was 32.2 months. After the matching procedure, the median disease-free survival was 17.2 months and median overall survival was 28.2 months.
Disease-free survival in our population-based study was considerably longer than the placebo population of CheckMate-577 (19.7 11.0 months). Possible explanations are differences in characteristics, quality of esophageal cancer care, or differential strategies for evaluation of recurrence. In the Netherlands postoperative imaging is not part of the standard follow-up as opposed to the standard postoperative imaging in the CheckMate 577 trial. The difference in postoperative imaging could partially explain the longer disease-free survival observed in our study. Quality and optimization of current treatment modalities remain important aspects of esophageal cancer care.
CheckMate 577试验结果显示，与安慰剂相比，接受辅助纳武利尤单抗治疗的食管或胃食管交界癌切除患者的无病生存期得到改善（22.4对11.0个月）。基于人群的数据可以为临床实践中的治疗结果提供见解。我们研究的目的是调查符合CheckMate 577纳入标准的全国范围内人群的无病生存期和总生存期。
从荷兰癌症登记处选取2015 - 2016年接受新辅助放化疗的II/III期食管或胃食管交界癌切除患者。排除颈段食管癌、切除不彻底或病理完全缓解的患者。使用Kaplan-Meier方法从切除后12周开始评估无病生存期和总生存期。此外，为了调整CheckMate 577与我们基于人群的队列之间的特征差异，对病理淋巴结状态和病理肿瘤状态进行了匹配调整间接比较。
我们确定了634例患者。60%的患者在随访结束时被诊断为复发或死亡。中位无病生存期为19.7个月，中位总生存期为32.2个月。匹配程序后，中位无病生存期为17.2个月，中位总生存期为28.2个月。
我们基于人群的研究中的无病生存期比CheckMate - 577试验中的安慰剂组显著更长（19.7对11.0个月）。可能的解释是特征差异、食管癌护理质量或复发评估策略不同。在荷兰，术后影像学检查不是标准随访的一部分，这与CheckMate 577试验中的标准术后影像学检查不同。术后影像学检查的差异可能部分解释了我们研究中观察到的更长的无病生存期。当前治疗模式的质量和优化仍然是食管癌护理的重要方面。
