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Eur J Cancer. 2016 Mar;56:59-68. doi: 10.1016/j.ejca.2015.11.024. Epub 2016 Jan 23.

Role of neoadjuvant treatment in clinical T2N0M0 oesophageal cancer: results from a retrospective multi-center European study.

Author information

1
Department of Surgery & Cancer, Imperial College, London, UK.
2
Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, Lille, France; North of France University, Lille, France; Inserm UMR S-1172, Team 5 "Mucins, Epithelial Differenciation and Carcinogenesis", JPARC, Lille, France.
3
Department of Digestive Surgery of Edouard Herriot University Hospital, Lyon, France.
4
North of France University, Lille, France; SIRIC OncoLille, France; Department of Biostatistics, University Hospital, Lille, France.
5
Cavale Blanche University Hospital, Brest, France.
6
Estaing University Hospital, Clermont-Ferrand, France.
7
Côte de Nacre University Hospital, Caen, France.
8
Hautepierre University Hospital, Strasbourg, France.
9
Pontchaillou University Hospital, Rennes, France.
10
Haut-Levêque University Hospital, Bordeaux, France.
11
Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, Lille, France; North of France University, Lille, France; Inserm UMR S-1172, Team 5 "Mucins, Epithelial Differenciation and Carcinogenesis", JPARC, Lille, France; SIRIC OncoLille, France. Electronic address: christophe.mariette@chru-lille.fr.

Abstract

AIMS:

The aims of this study were to compare short- and long-term outcomes for clinical T2N0 oesophageal cancer with analysis of (i) primary surgery (S) versus neoadjuvant therapy plus surgery (NS), (ii) squamous cell carcinoma and adenocarcinoma subsets; and (iii) neoadjuvant chemoradiotherapy versus neoadjuvant chemotherapy.

METHODS:

Data were collected from 30 European centres from 2000 to 2010. Among 2944 included patients, 355 patients (12.1%) had cT2N0 disease; 285 (S) and 70 (NS), were compared in terms of short- and long-term outcomes. Propensity score matching analyses were used to compensate for differences in baseline characteristics.

RESULTS:

No significant differences between the groups were shown in terms of in hospital morbidity and mortality. Nodal disease was observed in 50% of S-group at the time of surgery, with 20% pN2/N3. Utilisation of neoadjuvant therapy was associated with significant tumour downstaging as reflected by increases in pT0, pN0 and pTNM stage 0 disease, this effect was further enhanced with neoadjuvant chemoradiotherapy. After adjustment on propensity score and confounding factors, for all patients and subset analysis of squamous cell and adenocarcinoma, neoadjuvant therapy had no significant effect upon survival or recurrence (overall, loco-regional, distant or mixed) compared to surgery alone. There were no significant differences between neoadjuvant chemotherapy and chemoradiotherapy in short- or long-term outcomes.

CONCLUSION:

The results of this study suggest that a surgery alone treatment approach should be recommended as the primary treatment approach for cT2N0 oesophageal cancer despite 50% of patients having nodal disease at the time of surgery.

KEYWORDS:

Neoadjuvant treatment; Oesophageal cancer; Review; Surgery; Survival; cT2N0M0

PMID:
26808298
DOI:
10.1016/j.ejca.2015.11.024
[Indexed for MEDLINE]

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