Does Pathological Stage and Nodal Involvement Influence Long Term Oncological Outcomes after CROSS Regimen for Adenocarcinoma of the Esophagogastric Junction? A Multicenter Retrospective Analysis
by
, , ,
Stefano de Pascale
1,*
,
Paolo Parise
2,
Michele Valmasoni
3,
Jacopo Weindelmayer
4,
Fabrizia Terraneo
5,
Chiara Alessandra Cella
6,7,
Simone Giacopuzzi
4,
Andrea Cossu
2,
Simonetta Massaron
2,
Ugo Elmore
2,
Stefano Merigliano
3,
Uberto Fumagalli Romario
1 and 
on behalf of the Italian Society for the Study of Esophageal Diseases (SISME)
1
Department of Surgery, European Institute of Oncology IRCCS, 20141 Milan, Italy
2
Department of Gastrointestinal Surgery, San Raffaele Scientific Institute, 20132 Milan, Italy
3
Department of Surgical, Oncological and Gastrointestinal Sciences, University of Padova, Clinica Chirurgica 3, 35128 Padova, Italy
4
General and Upper GI Surgery Division, University of Verona, 37129 Verona, Italy
5
Department of Radiotherapy, Spedali Civili di Brescia, 25123 Brescia, Italy
6
Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology (IEO), 20143 Milan, Italy
7
Departement of Molecular and Translational Medicine, University of Brescia, 25121 Brescia, Italy
*
Author to whom correspondence should be addressed.
Cancers 2021, 13(4), 666; https://doi.org/10.3390/cancers13040666
Submission received: 27 December 2020
/
Revised: 26 January 2021
/
Accepted: 29 January 2021
/
Published: 7 February 2021
(This article belongs to the Special Issue Treatment of Gastric Cancer)
Simple Summary
Chemoradiotherapy according to CROSS regimen is the standard of care for locally advanced esophageal cancer. The studies conducted on this topic have demonstrated the benefits of this type of treatment particularly for squamocellular cancers. Its application for adenocarcinoma has evidenced different results and few studies have investigated its role for adenocarcinomas of esophagogastric junction. Our intent is to evaluate the relation between pathological (yp) stage after CROSS regimen followed by surgery for adenocarcinoma of cardia and overall (OS) and disease-free survival (DFS) in a retrospectively analyzed group of patients. Sites of relapse after surgery were also analyzed. Our results evidenced no differences in term of OS and DFS according to different pathological response after chemoradiotherapy and surgery. Further analyses could be performed to identify the histological and molecular characteristics of these tumors and predict the efficacy of systemic therapy identifying patients who can most benefit from this type of treatment.
Abstract
Background:After the results reported by the “Chemoradiotherapy for esophageal Cancer Followed by Surgery Study” (CROSS) trial, neo-adjuvant chemoradiotherapy became the standard treatment for locally advanced cancers of esophagus and gastroesophageal junction (GEJ). Excellent results were reported for squamocellular carcinomas (SCCs). Since the advent of the CROSS regimen, the results of surgery for esophageal adenocarcinomas (EAC) have cast some doubts about its efficacy on overall survival (OS) even in the presence of local response. This study evaluated the relation between pathological (yp) stage after CROSS regimen followed by surgery for adenocarcinoma of cardia and overall (OS) and disease-free survival (DFS). Sites of relapse after surgery were also analyzed. Methods: Patients submitted to the CROSS regimen for locally advanced EAC of the cardia followed by transthoracic esophagectomy were analyzed. Actuarial OS and DFS were analyzed and stratified according to yp stage. The site of relapse, distal and local, was also analyzed. Results: The study included 132 patients. The 50-month OS and DFS were 45% and 6.7%, respectively. No differences emerged analyzing OS according to yp stage. Time to relapse was significantly longer for yp Stage I and II, and for yp N0, compared with yp N+. Recurrence occurred in 48 cases (36.3%) with a 9 months median time to relapse. Local and distal relapse were 10 (7.5%) and 38 (28.7%) cases, respectively (p ≦ 0.001). Conclusions: Pathological stage after CROSS regimen does not relate to OS and DFS. Time to recurrence is significantly longer for yp Stages I and II and ypN0. Chemoradiotherapy in a neoadjuvant setting may influence the site of relapse, significantly reducing local recurrences.
