Adjuvant therapy following neoadjuvant chemotherapy and surgery for oesophageal adenocarcinoma in patients with clear resection margins

Abstract

Background

The role of adjuvant therapy in patients with oesophagogastric adenocarcinoma treated by neoadjuvant chemotherapy (NAC) and surgery is contentious. In UK practice, surgical resection margin status is often used to classify patients into receiving adjuvant treatment. This study aimed to assess any survival benefit of adjuvant therapy in patients with clear resection margins.

Methods

This was a retrospective collaborative cohort study combining two prospectively collected UK institutional databases of patients with oesophageal adenocarcinoma. Multivariable Cox regression and propensity matched analyses were used to compare overall and recurrence-free survival according to the adjuvant treatment.

Results

Of 374 patients with clear resection margins, 221 patients (59%) had no adjuvant treatment, 137 patients (37%) had adjuvant chemotherapy and 16 patients (4%) had adjuvant chemoradiotherapy. For patients who had received NAC (290, 76%), when adjuvant chemotherapy was compared to no adjuvant treatment, hazard ratios (HRs) favoured adjuvant chemotherapy but did not reach independent significance (overall survival [OS] HR 0.65 95% confidence interval [CI] 0.40–1.06; p .0.087). Responders to NAC (Mandard 1–3) were seemingly more likely to demonstrate a survival benefit from adjuvant chemotherapy (HR 0.42 95% CI 0.15–1.11; p .1.081).

Conclusions

Although no independent survival benefit was observed, the point estimates favoured adjuvant treatment, predominantly in patients with chemo-responsive tumours.

Keywords:

• Oesophageal adenocarcinoma
• adjuvant therapy
• neoadjuvant chemotherapy
• surgery

Acknowledgments

The authors acknowledge RM Partners, Accountable Cancer Network for the Pan London Clinical Research Fellowship Grant received. The authors acknowledge that the work included in this article was presented in abstract form at the following scientific meetings:

13th International Gastric Cancer Congress, 8–11 May 2019, Prague, Czech Republic- Poster Presentation.

AUGIS 22nd Annual Scientific Meeting, 25–27 September 2019, Liverpool, UK- Poster Presentation.

European Society for Diseases of the Esophagus meeting, 20–22nd November, Athens, Greece- Poster Presentation.

Ethics approval and consent

Ethics approval was gained for the clinical data used in this study. Ethics Committee- Northwest-Haydock Research Ethics Committee. REC Number 12/NW/0511.

Disclosure statement

Dr Nick Maisey – BMS, Servier. Professor David Cunningham – Amgen, Merrimack, Celgene, Bayer, Clovis, Janssen, Sanofi, AstraZeneca, MedImmune, 4SC, Eli Lily, Merck. Dr Elizabeth Smyth – Aptitude Health, Astra Zeneca, BMS, Celgene, Elsevier, Everest Clinical Research, First Word Group, Five Prime Therapeutics, Gritstone Oncology, Imedex, Merck, My Personal Therapeutics, Roche, Sai-Med, Servier, Zymeworks. All remaining authors have no conflicts of interest to declare.

Data availability statement

All data used in this study are available upon request to the corresponding author, Mr Andrew Davies. This article has not been deposited on a pre-print server.

Additional information

Funding

This work was supported by RM Partners Accountable Cancer Network (Pan London Clinical Research Fellowship Grant, 2017).