Impact of postoperative chemotherapy on survival for oesophagogastric adenocarcinoma after preoperative chemotherapy and surgery. Issue 2 (15th December 2021)

• Record Type: Journal Article
• Authors: Rahman, Saqib; Thomas, Betsan; Maynard, Nick; Park, Min Hae; Wahedally, Muhammad; Trudgill, Nigel; Crosby, Tom; Cromwell, David A.; Underwood, Tim J.
• Is Part Of: British journal of surgery. Volume 109:Issue 2(2022)
• Page Start: 227
• Page End: 236
• Publication Date: 2021-12-15
• Subjects: Surgery -- Periodicals; 617.005
• DOI: 10.1093/bjs/znab427
• Languages: English
• ISSNs: 0007-1323

Abstract

Abstract: Background: Perioperative chemotherapy is widely used in the treatment of oesophagogastric adenocarcinoma (OGAC) with a substantial survival benefit over surgery alone. However, the postoperative part of these regimens is given in less than half of patients, reflecting uncertainty among clinicians about its benefit and poor postoperative patient fitness. This study estimated the effect of postoperative chemotherapy after surgery for OGAC using a large population-based data set. Methods: Patients with adenocarcinoma of the oesophagus, gastro-oesophageal junction or stomach diagnosed between 2012 and 2018, who underwent preoperative chemotherapy followed by surgery, were identified from a national-level audit in England and Wales. Postoperative therapy was defined as the receipt of systemic chemotherapy within 90 days of surgery. The effectiveness of postoperative chemotherapy compared with observation was estimated using inverse propensity treatment weighting. Results: Postoperative chemotherapy was given to 1593 of 4139 patients (38.5 per cent) included in the study. Almost all patients received platinum-based triplet regimens (4004 patients, 96.7 per cent), with FLOT used in 3.3 per cent. Patients who received postoperative chemotherapy were younger, with a lower ASA grade, and were less likely to have surgical complications, with similar tumour characteristics. After weighting, the median survival time after postoperative chemotherapy was 62.7 months compared with 50.4 months without chemotherapy (hazard ratio 0.84, 95 per cent c.i. 0.77 to 0.94; P = 0.001). Conclusion: This study has shown that postoperative chemotherapy improves overall survival in patients with OGAC treated with preoperative chemotherapy and surgery. Abstract : Less than half of patients undergoing perioperative chemotherapy for gastro-oesophageal adenocarcinoma receive postoperative cycles of treatment. This study aimed to quantify the benefit of postoperative chemotherapy using a large population-based data set and inverse propensity score weighting. A substantial benefit of postoperative chemotherapy was demonstrated (hazard ratio 0.84; median survival 62.7 versus 50.4 months; P < 0.001).