Long-term outcome after perioperative chemotherapy and surgery for gastro-esophageal adenocarcinoma

Background: The long-term fate of patients treated for resectable gastro-esophageal adenocarcinoma with perioperative chemotherapy outside randomized clinical trials (RCTs) is poorly described. In this national cohort, we report on outcomes after 12 years. Materials and methods: Baseline clinicopathological factors and blood tests were collected in 285 patients treated from May 2008 to June 2010, and postsurgical factors were collected in the 202 patients that were radically resected. Response to preoperative chemotherapy was assessed by postsurgical restaging. Additional information on second cancers, comorbidities, and competing causes of death was obtained. Results: Overall survival (OS) at 5 and 10 years was 31.9% and 24.2%, respectively. Multivariate analysis (MA) showed prognostic value of clinical T- and N-stage, dysphagia, and Charlson Comorbidity Index. Elevated leucocytes and lactate dehydrogenase, and low lymphocytes were additional adverse prognostic factors. Ten-year incidence rate of second cancers was 10.1%. OS at 5 and 10 years from radical surgery was 43.1% and 32.1%, respectively. MA showed prognostic value of postneoadjuvant pathological (yp) Union for International Cancer Control (UICC) stage and downstaging. However, downstaging was strongly correlated with clinical stage. At the 5-year landmark, marginally significant trends toward a favorable recurrence-free survival were associated with ypT0 and age <70 years, but only 3.4% experienced late recurrences. Postoperative complications caused a quarter of deaths in the half of radically resected patients who died without recurrence. Conclusions: Five-year OS was 4%-6% points inferior to RCTs. Pretreatment white blood cell counts, but not postoperative, could supplement clinical prognostic factors. Downstaging by preoperative chemotherapy was prognostic but correlated strongly with pretreatment clinical stage.