Adjuvant Chemotherapy for Patients with Adenocarcinoma of the Esophagogastric Junction: A Retrospective, Multicenter, Observational Study

作者：Nie, Run-Cong; Luo, Tian-Qi; Li, Guo-Dong; Zhang, Fei-Yang; Chen, Guo-Ming; Li, Jin-Xing; Chen, Xiao-Jiang; Zhao, Zhou-Kai; Jiang, Kai-Ming; Wei, Yi-Cheng; Huang, Ming-Wei^*; Chen, Shi^*; Chen, Ying-Bo^*

来源：Annals of Surgical Oncology, 2022.

DOI：10.1245/s10434-022-12830-4

• GASTRIC-CANCER
• PERIOPERATIVE CHEMOTHERAPY
• OPEN-LABEL
• SURGERY
• CAPECITABINE
• OXALIPLATIN

Background. Although the incidence of adenocarcinoma of the esophagogastric junction (AEG) has been increasing since the past decade, the proportion of AEG cases in two previous clinical trials (ACTS-GC and CLASSIC) that investigated the efficacy of adjuvant chemotherapy was relatively small. Therefore, whether AEG patients can benefit from adjuvant chemotherapy remains unclear.Methods. Patients who were diagnosed with pathological stage II/III, Siewert II/III AEG, and underwent curative surgery at three high-volume institutions were assessed. Clinical outcomes were analyzed by using Kaplan-Meier curves, log-rank test, and Cox regression model. Propensity score matching (PSM) was used to reduce the selection bias.Results .A total of 927 patients were included (the chemotherapy group: 696 patients; the surgery-only group: 231 patients). The median follow-up was 39.0 months. The 5-year overall survival was 63.1% (95% confidence interval [CI]: 59.0-67.6%) for the chemotherapy group and 50.2% in the surgery-only group (hazard ratio [HR] = 0.69, 95% CI: 0.54-0.88; p = 0.003). The 5-year, disease-free survival was 35.4% for the chemotherapy group and 16.6% for the surgery-only group (HR = 0.66, 95% CI: 0.53-0.83; p < 0.001). After PSM, the survival benefit of adjuvant chemotherapy for AEG was maintained. Multivariate analysis for overall survival and disease-free survival further demonstrated the survival benefit of adjuvant chemotherapy, with HRs of 0.63 (p < 0.001) and 0.52 (p < 0.001), respectively.Conclusions .Postoperative adjuvant chemotherapy was associated with improved overall survival and disease-free survival in patients with operable stage II or III AEG after D2 gastrectomy.

• 单位
  中山大学; 6; 哈尔滨医科大学