Elshaer Ahmed Mohammed, Wijeyaratne Manuk, Higgs S M, Hornby S T, Dwerryhouse S J
Department of Upper Gastrointestinal Surgery, Gloucestershire Hospitals NHS Trust, Gloucester, United Kingdom; Cairo University Hospitals (Kasr-Alainy Hospital), Cairo, Egypt.
Department of Upper Gastrointestinal Surgery, Gloucestershire Hospitals NHS Trust, Gloucester, United Kingdom.
Eur J Surg Oncol. 2023 Oct;49(10):107016. doi: 10.1016/j.ejso.2023.107016. Epub 2023 Aug 11.
Gastro-oesophageal junctional (GOJ) cancers have been, more latterly, considered a distinct tumor entity with characteristic genetic profiles. The optimal multimodal therapy of advanced GOJ cancers remains debatable. In this comparative study, we analyzed the outcomes of peri-operative chemotherapy (CT) versus pre-operative chemoradiotherapy (CRT) in treatment of advanced GOJ adenocarcinomas.
This study included patients with locally advanced but resectable GOJ adenocarcinomas who underwent surgical resection after oncological therapy between 2010 till 2019 at our institution. Follow up to May 2021 was completed. The outcomes between CT and CRT groups were retrospectively analyzed. The long-term follow up data was obtained via direct contact with the patients during oncological clinics, cross-checked with hospital/national patients' electronic databases.
107 patients had GOJ cancers; 90 (84%) patients met our inclusion criteria. Perioperative chemotherapy was administrated in 65 (72%) patients. Overall median survival rate was 2.2 years in CRT-group compared to 2.4 years in CT-group (p-value 0.29), with comparable recurrence rates (48% vs 36% respectively). R0-resections were higher in CRT-group (84%) compared to CT-group (71%), yet insignificant p-value 0.197. Preoperative chemoradiotherapy achieved higher complete pathological response (28% vs 6%, p-value 0.009) and negative lymph nodes rates (64% vs 37%, p-value 0.014) compared to CT-group. Short-term outcomes (postoperative complications, morbidity rates and length of hospital stay) were similar across both groups.
Preoperative chemoradiotherapy was associated with higher complete pathological response and negative lymph nodes rates for GOJ adenocarcinomas compared to peri-operative chemotherapy, without an increase in postoperative complications or morbidity rates. However, it wasn't associated with improved overall or disease-free survival rates.
胃食管交界部（GOJ）癌近来被认为是具有独特基因图谱的一种不同的肿瘤实体。晚期GOJ癌的最佳多模式治疗仍存在争议。在这项比较研究中，我们分析了围手术期化疗（CT）与术前放化疗（CRT）治疗晚期GOJ腺癌的疗效。
本研究纳入了2010年至2019年期间在我们机构接受肿瘤治疗后进行手术切除的局部晚期但可切除的GOJ腺癌患者。随访至2021年5月完成。对CT组和CRT组的疗效进行回顾性分析。长期随访数据是通过在肿瘤门诊直接与患者联系获得的，并与医院/国家患者电子数据库进行交叉核对。
107例患者患有GOJ癌；90例（84%）患者符合我们的纳入标准。65例（72%）患者接受了围手术期化疗。CRT组的总中位生存率为2.2年，而CT组为2.4年（p值0.29），复发率相当（分别为48%和36%）。CRT组的R0切除率（84%）高于CT组（71%），但p值无统计学意义，为0.197。与CT组相比，术前放化疗实现了更高的完全病理缓解率（28%对6%，p值0.009）和阴性淋巴结率（64%对37%，p值0.014）。两组的短期结局（术后并发症、发病率和住院时间）相似。
与围手术期化疗相比，术前放化疗与GOJ腺癌更高的完全病理缓解率和阴性淋巴结率相关，且术后并发症或发病率没有增加。然而，它与总体生存率或无病生存率的改善无关。
