Gebauer Florian, Plum Patrick S, Damanakis Alexander, Chon Seung-Hun, Popp Felix, Zander Thomas, Quaas Alexander, Fuchs Hans, Schmidt Thomas, Schröder Wolfgang, Bruns Christiane J
Department of General, Visceral, Cancer and Transplantation Surgery, Faculty of Medicine, University Hospital Cologne, Cologne, Germany.
Gastrointestinal Cancer Group Cologne (GCGC), Cologne, Germany.
Ann Surg Oncol. 2023 Nov;30(12):7422-7433. doi: 10.1245/s10434-023-13643-9. Epub 2023 May 21.
The question of the ideal neoadjuvant therapy for locally advanced esophagogastric adenocarcinoma has not been answered to date. Multimodal treatment has become a standard treatment for these adenocarcinomas. Currently, perioperative chemotherapy (FLOT) or neoadjuvant chemoradiation (CROSS) is recommended.
A monocentric retrospective analysis compared long-term survival after CROSS versus FLOT. The study enrolled patients with adenocarcinoma of the esophagus (EAC) or the esophagogastric junction type I or II undergoing oncologic Ivor-Lewis esophagectomy between January 2012 and December 2019. The primary objective was to determine the long-term outcome in terms of overall survival. The secondary objectives were to determine differences regarding the histopathologic categories after neoadjuvant treatment and the histomorphologic regression.
The findings showed no survival advantage for one or the other treatment in this highly standardized cohort. All the patients underwent open (CROSS: 9.4% vs. FLOT: 22%), hybrid (CROSS: 82% vs. FLOT: 72%), or minimally invasive (CROSS: 8.9% vs. FLOT: 5.6%) thoracoabdominal esophagectomy. The median post-surgical follow-up period was 57.6 months (95% confidence interval [CI] 23.2-109.7 months), and the median survival was longer for the CROSS patients (54 months) than for the FLOT patients (37.2 months) (p = 0.053). The overall 5-years survival was 47% for the entire cohort (48% for the CROSS and 43% for the FLOT patients). The CROSS patients showed a better pathologic response and fewer advanced tumor stages.
The improved pathologic response after CROSS cannot be translated into longer overall survival. To date, the choice of which neoadjuvant treatment to use can be made only on the basis of clinical parameters and the patient's performance status.
对于局部晚期食管胃腺癌，理想的新辅助治疗方案问题至今仍未得到解答。多模式治疗已成为这些腺癌的标准治疗方法。目前，推荐围手术期化疗（FLOT方案）或新辅助放化疗（CROSS方案）。
一项单中心回顾性分析比较了CROSS方案与FLOT方案后的长期生存率。该研究纳入了2012年1月至2019年12月期间接受肿瘤学Ivor-Lewis食管切除术的食管腺癌（EAC）或I型或II型食管胃交界腺癌患者。主要目的是确定总体生存方面的长期结果。次要目的是确定新辅助治疗后组织病理学类别和组织形态学消退方面的差异。
研究结果表明，在这个高度标准化的队列中，两种治疗方法在生存方面均无优势。所有患者均接受了开放手术（CROSS方案组：9.4% vs. FLOT方案组：22%）、杂交手术（CROSS方案组：82% vs. FLOT方案组：72%）或微创手术（CROSS方案组：8.9% vs. FLOT方案组：5.6%）胸腹联合食管切除术。术后中位随访期为57.6个月（95%置信区间[CI] 23.2 - 109.7个月），CROSS方案组患者的中位生存期（54个月）长于FLOT方案组患者（37.2个月）（p = 0.053）。整个队列的5年总生存率为47%（CROSS方案组为48%，FLOT方案组为43%）。CROSS方案组患者显示出更好的病理反应和更少的晚期肿瘤分期。
CROSS方案后改善的病理反应并未转化为更长的总生存期。迄今为止，新辅助治疗方案的选择只能基于临床参数和患者的体能状态来做出。
