Beyond Pathological Complete Response: Long-term Outcomes in Esophageal and Esophagogastric Junction Adenocarcinoma After Multimodal Therapy-A Systematic Review and Individual Patient-Data Meta-Analysis.
Luca Risi, Renato De Martino, Lorenzo Giorgi et al.
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In 30 seconds
This systematic review and individual patient-data meta-analysis compared long-term outcomes after neoadjuvant chemotherapy (nCT) versus chemoradiotherapy (nCRT) in patients with esophageal or esophagogastric junction adenocarcinoma who achieved pathological complete response. Six studies contributed 1,454 patients: 374 treated with nCT and 1,080 with nCRT. Overall survival was higher after nCT at each reported time point; 5-year survival was 73.8% versus 56% (p < 0.001). The analysis also associated nCT with lower risks of death and recurrence, suggesting that outcomes among patients with complete response differ by preoperative treatment strategy.
Key findings
- Five-year overall survival was 73.8% after nCT versus 56% after nCRT (p < 0.001).
- One-stage meta-analysis associated nCT with decreased risk of death (HR = 0.49, p < 0.001).
- nCT was associated with decreased risk of recurrence (HR = 0.24, p <0.001); disease-free survival was superior at one, three and five years (p < 0.001).
Why it matters
Pathological complete response does not, by itself, capture the differing long-term outcomes associated with the neoadjuvant strategy. These findings suggest that systemic disease control may contribute to prognosis even among patients with complete response, and that treatment context matters when interpreting this response as a prognostic marker.
What to keep in mind
The analysis included only six studies, and the abstract does not report whether treatment allocation was randomised; comparisons may therefore be affected by differences between treatment groups.