Pape Marieke, Vissers Pauline A J, Dijksterhuis Willemieke P M, Bertwistle David, McDonald Laura, Mostert Bianca, Derks Sarah, Oving Irma M, Verhoeven Rob H A, van Laarhoven Hanneke W M
Department of Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands.
Amsterdam UMC location University of Amsterdam, Medical Oncology, Amsterdam, the Netherlands.
Ther Adv Med Oncol. 2023 Mar 21;15:17588359231162576. doi: 10.1177/17588359231162576. eCollection 2023.
Treatment of advanced or metastatic esophageal adenocarcinoma (EAC) follows the guidelines for gastroesophageal junction adenocarcinoma (GEJC) and gastric adenocarcinoma (GAC), but patients with EAC are often excluded from clinical studies of GEJC/GAC.
Here we describe treatment and survival of patients with advanced EAC, GEJC, and GAC to provide population-based evidence on distinctions and similarities between these populations.
Retrospective cohort study of patients with unresectable advanced (cT4b) or metastatic (cM1) EAC, GEJC, or GAC (2015-2020) were selected from the Netherlands Cancer Registry.
Overall survival (OS) was assessed using Kaplan-Meier methods, log-rank tests, and multivariable Cox regression.
In all, 7391 patients were included (EAC: = 3346, GEJC: = 1246, and GAC: = 2798). Patients with EAC were more often males and more often had ⩾2 metastatic locations. First-line systemic therapy was received by 42%, 47%, and 36% of patients with EAC, GEJC, and GAC, respectively. Median OS was 5.0, 5.1, and 4.0 months for all patients with EAC, GEJC, and GAC, respectively ( < 0.001). Median OS from start of first-line therapy of patients with human epidermal growth factor receptor 2 (HER2)-negative adenocarcinomas was 7.6, 7.8, and 7.5 months ( = 0.12) and of patients with HER2-positive carcinoma receiving first-line trastuzumab-containing therapy was 11.0, 13.3, and 9.5 months ( = 0.37) in EAC, GEJC, and GAC, respectively. After multivariable adjustment, no difference in OS for patients with EAC, GEJC, and GAC was observed.
Despite differences in clinical characteristics and treatment strategies, survival between patients with advanced EAC, GEJC, and GAC was similar. We advocate that EAC patients should not be excluded from clinical trials for patients with molecularly similar GEJC/GAC.
晚期或转移性食管腺癌（EAC）的治疗遵循胃食管交界腺癌（GEJC）和胃腺癌（GAC）的指南，但EAC患者通常被排除在GEJC/GAC的临床研究之外。
在此，我们描述晚期EAC、GEJC和GAC患者的治疗及生存情况，以提供基于人群的证据，说明这些人群之间的差异和相似之处。
对2015年至2020年从荷兰癌症登记处选取的无法切除的晚期（cT4b）或转移性（cM1）EAC、GEJC或GAC患者进行回顾性队列研究。
使用Kaplan-Meier方法、对数秩检验和多变量Cox回归评估总生存期（OS）。
共纳入7391例患者（EAC：3346例，GEJC：1246例，GAC：2798例）。EAC患者男性更多，且转移部位≥2个的情况更常见。EAC、GEJC和GAC患者分别有42%、47%和36%接受了一线全身治疗。所有EAC、GEJC和GAC患者的中位OS分别为5.0个月、5.1个月和4.0个月（<0.001）。人表皮生长因子受体2（HER2）阴性腺癌患者从一线治疗开始的中位OS在EAC、GEJC和GAC中分别为7.6个月、7.8个月和7.5个月（=0.12），接受含曲妥珠单抗一线治疗的HER2阳性癌患者的中位OS在EAC、GEJC和GAC中分别为11.0个月、13.3个月和9.5个月（=0.37）。多变量调整后，未观察到EAC、GEJC和GAC患者的OS有差异。
尽管临床特征和治疗策略存在差异，但晚期EAC、GEJC和GAC患者的生存情况相似。我们主张，EAC患者不应被排除在分子特征相似的GEJC/GAC患者的临床试验之外。
