Hoelscher, Arnulf H., Bollschweiler, Elfriede, Bogoevski, Dean, Schmidt, Henner, Semrau, Robert and Izbicki, Jakob R. (2014). Prognostic impact of neoadjuvant chemoradiation in cT3 oesophageal cancer - A propensity score matched analysis. Eur. J. Cancer, 50 (17). S. 2950 - 2958. OXFORD: ELSEVIER SCI LTD. ISSN 1879-0852

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Abstract

Background: The prognostic effect of neoadjuvant treatment in advanced oesophageal cancer is still debated because most studies included undefined T-stages, different radio/chemotherapies or different types of surgery. Objectives: To analyse the prognostic impact of neoadjuvant chemoradiation in patients with clinical T3 oesophageal cancer and oesophagectomy. Methods: In a retrospective study 768 patients from two centres with cT3/Nx/M0 oesophageal cancer and transthoracic en-bloc oesophagectomy were selected. Clinical staging was based on endoscopy, endosonography and spiral-CT scan. Propensity score matching using histology, location of tumour, age, gender and ASA-classification identified 648 patients (n = 302 adenocarcinoma (AC), n = 346 squamous cell carcinoma (SCC)) for the intention-to-treat analysis comparing group-I (n = 324) patients with planned oesophagectomy and group-II (n = 324) patients with planned neoadjuvant chemoradiation (40 Gy, 5-FU, cisplatin) followed by oesophagectomy. The prognosis was analysed by univariate and multivariate analyses. Results: In the intention-to-treat analysis group-I had a 17% and group-II a 28% 5-year survival rate (5-YSR) (p < 0.001). After excluding patients without oesophagectomy the 5-YSR of group-II increased to 30%. The results were more favourable for patients with AC (5y-SR of 38%) compared to SCC (22%) (p = 0.060). In group-II patients with major response (n = 128) had a 41% 5-YSR compared to 20% for those with minor response (n = 155, p < 0,001). In multivariate analysis neoadjuvant chemoradiation was a favourable independent prognostic factor. Conclusion: Neoadjuvant chemoradiation followed by oesophagectomy results in 11% higher 5-YSR than surgery alone for patients with cT3/Nx/M0 oesophageal cancer. This effect is due to the substantial prognostic benefit of the major responders. (C) 2014 Elsevier Ltd. All rights reserved.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Hoelscher, Arnulf H.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Bollschweiler, ElfriedeUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Bogoevski, DeanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schmidt, HennerUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Semrau, RobertUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Izbicki, Jakob R.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-424489
DOI: 10.1016/j.ejca.2014.08.020
Journal or Publication Title: Eur. J. Cancer
Volume: 50
Number: 17
Page Range: S. 2950 - 2958
Date: 2014
Publisher: ELSEVIER SCI LTD
Place of Publication: OXFORD
ISSN: 1879-0852
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
PERIOPERATIVE CHEMOTHERAPY; COMPLETE RESPONSE; LYMPH-NODES; SURVIVAL; SURGERY; CHEMORADIOTHERAPY; CARCINOMA; THERAPY; NUMBER; TUMORMultiple languages
OncologyMultiple languages
URI: http://kups.ub.uni-koeln.de/id/eprint/42448

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