Adjuvant Chemoradiotherapy Vs Neoadjuvant/Perioperative Chemotherapy in Resectable Gastro-esophageal Junction Adenocarcinomas- a Retrospective Analysis

摘要

We aimed to conduct the retrospective analysis of resectable Gastro-esophageal junctionadenocarcinomas treated at our facility with either adjuvant chemoradiotherapy (ACT) or neoadjuvant/perioperative chemotherapy (NACT) and investigate their impact on the clinical outcome.A total of79 patients of Gastro -esophageal junction adenocarcinomas completed treatment with curative intentbetween January, 2010 and December 2016 and were included in the analysis. 33 patients receivedadjuvant chemoradiotherapy after curative surgery as per Intergroup 0116 protocol. 46 patientsunderwent curative surgery after 3 cycles of neoadjuvant /perioperative chemotherapy as per UKMAGIC trial regimen. Statistical analysis was done with SPSS version 16 software.The patientsincluded 68 males and 11 females with age ranging from 22-81 years (median 60 years). The followup ranged from 6-71 months (median 14 months). The number of lymph nodes removed at surgerywas 5-25 (median 12). Only 6 patients were node negative in the whole cohort. The number ofpositive lymph nodes ranged from 1-9 in rest of the 73 patients. 12.65% (n=10) patients were diagnosedwith stage IIB, 44.3% (n=35) patients had stage IIIA, 29.1 %( n= 23) patients had stage IIIB and13.9% (n=11) patients had stage IIIC disease. In the adjuvant chemoradiotherapy group, out of 33patients, 7 were dead of disease and 12 were alive with disease at last follow up. In the neoadjuvant/perioperative cohort, out of 46 patients, 13 were dead and 16 were alive with disease. Mediandisease free survival in the adjuvant chemoradiotherapy group was 22 months versus 14 months inthe neoadjuvant/perioperative cohort. The difference was significant on Breslow analysis (GeneralizedWilcoxon, p=.014) and on Tarone Ware (p=.037) but not on Log rank (Mantel-Cox, p=.190) implyingmore of the early events in the NACT group. Hazards ratio for ACT vs. NACT was 0 .703(95% CI0.376-1.317, p=0.272). Hazard ratio for positive nodes was 1.125 ( 95% CI 0.96-1.318,p=0.145).Median DFS for the whole group was18 months(SE 2.912,CI 12.292-23.708) and meanDFS was 23.725 months (SE 2.452, CI 18.919-28.532). Patients receiving adjuvant chemotherapyafter surgery had median overall survival of 39 months versus 26 months in the neoadjuvant arm{p=.039, Wilcoxon Gehan statistic}.In our clinical set-up, adjuvant chemoradiotherapy seems to resultin better overall survival and disease free survival in resectable gastro-esophageal junctionadenocarcinoma though we should be cautious in interpreting retrospective and non-randomizeddata.