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Neoadjuvant chemotherapy for carcinoma of the oesophagus and oesophago-gastric junction: a six-year experience.

Halliday BP, Skipworth RJ, Wall L, Phillips HA, Couper GW, de Beaux AC, Paterson-Brown S - Int Semin Surg Oncol (2007)

Bottom Line: This non-randomised study demonstrated that NAC was associated with a significant reduction in post-operative inpatient mortality rate.Whether this can be explained by a decreased co-morbidity in NAC patients or a protective phenomenon associated with NAC remains unclear.This study also demonstrated a greater two-year survival rate and overall median survival time following NAC but this was not statistically significant.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK. Simon.Paterson-Brown@luht.scot.nhs.uk.

ABSTRACT

Background: Oesophageal cancer is a major clinical problem with a generally poor prognosis. As a result there has been interest in combining surgery with neoadjuvant chemotherapy to try and improve outcomes, although the current evidence for benefit is inconsistent. We aimed to compare, in a non-randomised study, the post-operative complication rate and short and long-term survival of patients who underwent surgical resection for carcinoma of the oesophagus and types I and II carcinoma of the oesophago-gastric junction with or without neo-adjuvant chemotherapy.

Methods: Details of all resections for oesophageal/junctional (types I and II) adenocarcinoma or squamous cell carcinoma between April 2000 and July 2006 were collected prospectively. Data from patients with T3 and/or N1 disease who underwent either neoadjuvant chemotherapy (NAC) or not (non-NAC) were compared. Data were analysed using Kaplan-Meier plots, Mann-Whitney U-test, Cox Regression modelling, and Chi-squared test with Yates' correction where sample sizes <10.

Results: 167 patients were included (89 NAC and 78 non-NAC). The in-hospital post-operative mortality rate of the NAC group (n = 2 deaths; 2.2%) was significantly lower (p = 0.045) than the non-NAC group (n = 6 deaths; 7.7%). Most deaths were due to cardio-respiratory complications; however, there was no significant difference in rates of chest infections, anastomotic leaks, wound infections, re-operations, readmission to ITU or overall complications between the two groups. Although both the two-year survival rate (60.7%) and long-term survival of NAC patients (median survival = 793 days; 95% CI = 390-1196) was greater than non-NAC patients (two-year survival rate = 48.7%; median survival = 554 days; 95% CI = 246-862 respectively), these differences were not statistically significant.

Conclusion: This non-randomised study demonstrated that NAC was associated with a significant reduction in post-operative inpatient mortality rate. Whether this can be explained by a decreased co-morbidity in NAC patients or a protective phenomenon associated with NAC remains unclear. This study also demonstrated a greater two-year survival rate and overall median survival time following NAC but this was not statistically significant.

No MeSH data available.


Related in: MedlinePlus

Kaplan-Meier survival curves of NAC and non-NAC patients with T2 and T3 disease. (T2/non-NAC: median survival: 552 days, 95% CI = 409–695 days; T2/NAC: median survival: 565 days, 95% CI = 361–769 days; T3/non-NAC: median survival: 554 days, 95% CI = 356–752 days; T3/NAC: median survival: 870 days, 95% CI = 407–1333 days; p = 0.65).
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Figure 3: Kaplan-Meier survival curves of NAC and non-NAC patients with T2 and T3 disease. (T2/non-NAC: median survival: 552 days, 95% CI = 409–695 days; T2/NAC: median survival: 565 days, 95% CI = 361–769 days; T3/non-NAC: median survival: 554 days, 95% CI = 356–752 days; T3/NAC: median survival: 870 days, 95% CI = 407–1333 days; p = 0.65).

Mentions: Median survival of the NAC group was 793 days (95% CI = 390–1196 days) compared with 554 days (95% CI = 246–862 days) in the non-NAC group. However, this difference did not reach statistical significance (p = 0.37) (Fig. 2). Two year survival rates for the NAC and non-NAC groups were 60.7% and 48.7% respectively (p = 0.16). This trend for improved survival in the NAC group was consistent when data were grouped and analysed by individual T and N stages (Figs. 3 &4). Univariate analysis demonstrated that patient age, sex, histological tumour type and pre-operative tumour stage did not significantly affect patient survival. Only post-operative stage as determined histopathologically affected patient survival significantly (p < 0.01). A Cox Regression model including post-operative stage and NAC status was generated, but this did not demonstrate a significant effect of NAC on the odds ratio (OR) of patient death (OR = 0.84; 95% CI = 0.55 – 1.27; p = 0.40).


Neoadjuvant chemotherapy for carcinoma of the oesophagus and oesophago-gastric junction: a six-year experience.

Halliday BP, Skipworth RJ, Wall L, Phillips HA, Couper GW, de Beaux AC, Paterson-Brown S - Int Semin Surg Oncol (2007)

Kaplan-Meier survival curves of NAC and non-NAC patients with T2 and T3 disease. (T2/non-NAC: median survival: 552 days, 95% CI = 409–695 days; T2/NAC: median survival: 565 days, 95% CI = 361–769 days; T3/non-NAC: median survival: 554 days, 95% CI = 356–752 days; T3/NAC: median survival: 870 days, 95% CI = 407–1333 days; p = 0.65).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2117002&req=5

Figure 3: Kaplan-Meier survival curves of NAC and non-NAC patients with T2 and T3 disease. (T2/non-NAC: median survival: 552 days, 95% CI = 409–695 days; T2/NAC: median survival: 565 days, 95% CI = 361–769 days; T3/non-NAC: median survival: 554 days, 95% CI = 356–752 days; T3/NAC: median survival: 870 days, 95% CI = 407–1333 days; p = 0.65).
Mentions: Median survival of the NAC group was 793 days (95% CI = 390–1196 days) compared with 554 days (95% CI = 246–862 days) in the non-NAC group. However, this difference did not reach statistical significance (p = 0.37) (Fig. 2). Two year survival rates for the NAC and non-NAC groups were 60.7% and 48.7% respectively (p = 0.16). This trend for improved survival in the NAC group was consistent when data were grouped and analysed by individual T and N stages (Figs. 3 &4). Univariate analysis demonstrated that patient age, sex, histological tumour type and pre-operative tumour stage did not significantly affect patient survival. Only post-operative stage as determined histopathologically affected patient survival significantly (p < 0.01). A Cox Regression model including post-operative stage and NAC status was generated, but this did not demonstrate a significant effect of NAC on the odds ratio (OR) of patient death (OR = 0.84; 95% CI = 0.55 – 1.27; p = 0.40).

Bottom Line: This non-randomised study demonstrated that NAC was associated with a significant reduction in post-operative inpatient mortality rate.Whether this can be explained by a decreased co-morbidity in NAC patients or a protective phenomenon associated with NAC remains unclear.This study also demonstrated a greater two-year survival rate and overall median survival time following NAC but this was not statistically significant.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK. Simon.Paterson-Brown@luht.scot.nhs.uk.

ABSTRACT

Background: Oesophageal cancer is a major clinical problem with a generally poor prognosis. As a result there has been interest in combining surgery with neoadjuvant chemotherapy to try and improve outcomes, although the current evidence for benefit is inconsistent. We aimed to compare, in a non-randomised study, the post-operative complication rate and short and long-term survival of patients who underwent surgical resection for carcinoma of the oesophagus and types I and II carcinoma of the oesophago-gastric junction with or without neo-adjuvant chemotherapy.

Methods: Details of all resections for oesophageal/junctional (types I and II) adenocarcinoma or squamous cell carcinoma between April 2000 and July 2006 were collected prospectively. Data from patients with T3 and/or N1 disease who underwent either neoadjuvant chemotherapy (NAC) or not (non-NAC) were compared. Data were analysed using Kaplan-Meier plots, Mann-Whitney U-test, Cox Regression modelling, and Chi-squared test with Yates' correction where sample sizes <10.

Results: 167 patients were included (89 NAC and 78 non-NAC). The in-hospital post-operative mortality rate of the NAC group (n = 2 deaths; 2.2%) was significantly lower (p = 0.045) than the non-NAC group (n = 6 deaths; 7.7%). Most deaths were due to cardio-respiratory complications; however, there was no significant difference in rates of chest infections, anastomotic leaks, wound infections, re-operations, readmission to ITU or overall complications between the two groups. Although both the two-year survival rate (60.7%) and long-term survival of NAC patients (median survival = 793 days; 95% CI = 390-1196) was greater than non-NAC patients (two-year survival rate = 48.7%; median survival = 554 days; 95% CI = 246-862 respectively), these differences were not statistically significant.

Conclusion: This non-randomised study demonstrated that NAC was associated with a significant reduction in post-operative inpatient mortality rate. Whether this can be explained by a decreased co-morbidity in NAC patients or a protective phenomenon associated with NAC remains unclear. This study also demonstrated a greater two-year survival rate and overall median survival time following NAC but this was not statistically significant.

No MeSH data available.


Related in: MedlinePlus