Kraemer Max, Wirsik Naita M, Alakus Hakan, Schloesser Hans A, Fuchs Hans, Schroeder Wolfgang, Bruns Christiane J, Lyu Su Ir, Baehr Friederike, Zander Thomas, Quaas Alexander
Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Gastrointestinal Cancer Group Cologne GCGC, University of Cologne, Cologne, Germany.
Department of General, Visceral, Cancer and Transplantation Surgery, University Hospital Cologne, Cologne, Germany.
Int J Cancer. 2025 Jul 22. doi: 10.1002/ijc.70048.
Oesophagogastric junction and gastric adenocarcinoma (OGA) are associated with high mortality rates, with 5-year survival rates below 50% in the curative setting. This study evaluates the efficacy of adjuvant chemotherapy (a chemotherapy regimen consisting of docetaxel, oxaliplatin, leucovorin and 5-fluorouracil [FLOT]) in patients with low tumour regression grades (TRG) following neoadjuvant FLOT (>10% viable tumour cells in surgical specimen, TRG 2/3 analogue Becker's classification). Data from all patients who had undergone ≥3 cycles of neoadjuvant FLOT with R0 resection and TRG 2/3 in surgical specimen, diagnosed between 2017 and 2020 at the University of Cologne (n = 134), were analyzed. Patients were categorised into three groups based on the administration of postoperative FLOT: 'FLOT complete' (four cycles), 'FLOT incomplete' (one to three cycles) and 'no FLOT' (0 cycles). Progression-free survival (PFS) and overall survival (OS) were compared. There is a statistically significant PFS advantage for the 'FLOT complete' group compared to 'no FLOT' (p = .028) in the total patient cohort and a tendency for an OS benefit. In the subgroup of patients with lymph node metastasis in surgical specimen (ypN+ cohort, n = 91), the PFS advantage of 'FLOT complete' was diminished and statistically no longer significant, and there is no OS benefit for these patients. However, multivariate analysis confirmed a significant PFS benefit for 'FLOT complete' both in the total cohort (p = .011) and in ypN+ patients (p = .018). These findings suggest that full adjuvant FLOT is beneficial even for OGA patients with low tumour regression; however, its efficacy appears reduced in those with lymph node metastasis, warranting further investigation into individualising treatment strategies.
食管胃交界部和胃腺癌（OGA）的死亡率很高，在可治愈的情况下，5年生存率低于50%。本研究评估辅助化疗（一种由多西他赛、奥沙利铂、亚叶酸钙和5-氟尿嘧啶组成的化疗方案[FLOT]）对新辅助FLOT后肿瘤退缩分级（TRG）较低的患者（手术标本中存活肿瘤细胞>10%，TRG 2/3，类似贝克尔分类法）的疗效。分析了2017年至2020年在科隆大学诊断的所有接受≥3周期新辅助FLOT且R0切除、手术标本TRG 2/3的患者的数据（n = 134）。根据术后FLOT的使用情况，将患者分为三组：“FLOT全疗程”（四个周期）、“FLOT非全疗程”（一至三个周期）和“未使用FLOT”（0个周期）。比较无进展生存期（PFS）和总生存期（OS）。在整个患者队列中，“FLOT全疗程”组与“未使用FLOT”组相比，PFS有统计学显著优势（p = 0.028），且有OS获益的趋势。在手术标本有淋巴结转移的患者亚组（ypN+队列，n = 91）中，“FLOT全疗程”的PFS优势减弱且在统计学上不再显著，这些患者没有OS获益。然而，多变量分析证实，“FLOT全疗程”在整个队列（p = 0.011）和ypN+患者（p = 0.018）中均有显著的PFS获益。这些发现表明，即使对于肿瘤退缩较低的OGA患者，全疗程辅助FLOT也是有益的；然而，其疗效在有淋巴结转移的患者中似乎有所降低，需要进一步研究个体化治疗策略。
