Universität zu Köln

Kraemer, Max ORCID: 0009-0006-9275-6121, Wirsik, Naita M. ORCID: 0000-0003-1619-6354, Alakus, Hakan ORCID: 0000-0002-3889-3276, Schloesser, Hans A. ORCID: 0000-0002-1304-7719, Fuchs, Hans ORCID: 0000-0003-4764-8050, Schroeder, Wolfgang ORCID: 0000-0002-8700-069X, Bruns, Christiane J. ORCID: 0000-0001-6590-8181, Lyu, Su Ir ORCID: 0009-0002-4125-6048, Baehr, Friederike, Zander, Thomas ORCID: 0000-0002-4266-6818 and Quaas, Alexander ORCID: 0000-0002-3537-6011 (2025). Adjuvant FLOT provides survival benefit for oesophagogastric junction and gastric adenocarcinoma patients with low tumour regression after neoadjuvant chemotherapy. International Journal of Cancer, 157 (12). pp. 2558-2568. Wiley. ISSN 0020-7136

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Abstract

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.

Item Type:	Article
Creators:	Creators Email ORCID ORCID Put Code Kraemer, Max UNSPECIFIED https://orcid.org/0009-0006-9275-6121 UNSPECIFIED Wirsik, Naita M. UNSPECIFIED https://orcid.org/0000-0003-1619-6354 UNSPECIFIED Alakus, Hakan UNSPECIFIED https://orcid.org/0000-0002-3889-3276 UNSPECIFIED Schloesser, Hans A. UNSPECIFIED https://orcid.org/0000-0002-1304-7719 UNSPECIFIED Fuchs, Hans UNSPECIFIED https://orcid.org/0000-0003-4764-8050 UNSPECIFIED Schroeder, Wolfgang UNSPECIFIED https://orcid.org/0000-0002-8700-069X UNSPECIFIED Bruns, Christiane J. UNSPECIFIED https://orcid.org/0000-0001-6590-8181 UNSPECIFIED Lyu, Su Ir UNSPECIFIED https://orcid.org/0009-0002-4125-6048 UNSPECIFIED Baehr, Friederike UNSPECIFIED UNSPECIFIED UNSPECIFIED Zander, Thomas UNSPECIFIED https://orcid.org/0000-0002-4266-6818 UNSPECIFIED Quaas, Alexander UNSPECIFIED https://orcid.org/0000-0002-3537-6011 UNSPECIFIED
URN:	urn:nbn:de:hbz:38-805303
Identification Number:	10.1002/ijc.70048
Journal or Publication Title:	International Journal of Cancer
Volume:	157
Number:	12
Page Range:	pp. 2558-2568
Number of Pages:	11
Date:	15 December 2025
Publisher:	Wiley
ISSN:	0020-7136
Language:	English
Faculty:	Faculty of Medicine
Divisions:	Faculty of Medicine > Chirurgie > Klinik und Poliklinik für Allgemein-, Viszeral-, Thorax- und Transplantationschirurgie Faculty of Medicine > Innere Medizin > Klinik I für Innere Medizin - Hämatologie und Onkologie Faculty of Medicine > Pathologie und Neuropathologie > Institut für Pathologie Faculty of Medicine > Weitere > Centrum für integrierte Onkologie (CIO)
Subjects:	Medical sciences Medicine
Uncontrolled Keywords:	Keywords Language adjuvant chemotherapy ; FLOT ; gastric adenocarcinoma ; oesophagogastric junction adenocarcinoma ; tumour regression English
['eprint_fieldname_oa_funders' not defined]:	Publikationsfonds UzK
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/80530