The impact of pathological tumor response following neoadjuvant chemotherapy and chemoradiotherapy for esophageal adenocarcinoma. A retrospective multicenter cohort study

Abstract Background Two multimodal strategies are available for the treatment of esophageal cancer: neoadjuvant chemotherapy (CT) and chemoradiotherapy (CTRT). The higher rate of pathological complete response (pCR) after CTRT is an argument to support this treatment. However, previous studies have failed to demonstrate a survival benefit of CTRT for adenocarcinoma (ADC) and the correlation between pathological tumor response (pTR) and survival is unclear. Methods This multicenter retrospective cohort study included data from 2 high-volume centers. Only patients with ADC who underwent CT or CTRT and surgery between 2012 and 2019 were included. The correlation between pTR and survival after both treatments was evaluated using Kaplan–Meier analysis. The 5-year overall (OS) and disease-free survivals (DFS) of patients showing pCR after the 2 treatments were compared. pTR was assessed using the Mandard tumor regression grade (TRG). Results Overall, 424 patients were included, 236 received CT and 188 CTRT. The incidence of pCR was 12.7% in the CT group and 26.1% after CTRT (p = 0.0005). At 5-years the OS rate after CT was 85.6% for TRG1 patients, 75.5% for TRG2, 57% for TRG3 and 42% for TRG4–5 (p = 0.004). After CTRT it was 72.8% for TRG1, 60.8% for TRG2, 39% for TRG3 and 27% for TRG4–5 (p = 0.0003) (figure 1). The OS of patients with pCR was not significantly different after CT and CTRT (p = 0.65). The 5-years DFS of pCR patients was higher in the CT group (86% vs. 70%, p = 0.05). Conclusion Despite a lower rate of pCR, both OS and, especially, DFS of pCR patients were improved after CT compared to CTRT. TRG showed to be significantly associated with survival in both treatment groups. The effectiveness of long-term disease control after CT and CTRT should be further analyzed in ADC.