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Impact of the Siewert Classification on the Outcome of Patients Treated by Preoperative Chemoradiotherapy for a Nonmetastatic Adenocarcinoma of the Oesophagogastric Junction.

Moureau-Zabotto L, Teissier E, Cowen D, Azria D, Ellis S, Resbeut M - Gastroenterol Res Pract (2015)

Bottom Line: The 3-year ORR was 48%.Using univariate analysis ORR was significantly increased for patients with Siewert II/III compared to Siewert I tumors (27.3% versus 62%, p = 0.047).For OGJA treated with preoperative CRT and surgery, ORR and CRMR were lower for patients with Siewert I tumors in comparison with Siewert II/III tumors.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Therapy, Institut Paoli Calmettes, 232 boulevard de Sainte Marguerite, 13009 Marseille, France.

ABSTRACT
The aim of the study is to analyze the impact of the Siewert classification on the pathological complete response (pcR), pattern of failure, and general outcome of patients treated, by preoperative chemoradiotherapy and surgery for an gastroesophageal junction adenocarcinoma (OGJA). From 2000 to 2008, the charts of 68 patients were retrospectively reviewed. Tumor staging reported was UST1/T2/T3/T4/unknown, respectively, n = 1/7/54/5/1 patients, and N0/N1/unknown, respectively, n = 9/58/1 patients. Patients received primary external-beam radiotherapy with concurrent chemotherapy followed by surgical resection (Siewert I: upper oesogastrectomy; Siewert II/III: total gastrectomy with lower oesophagectomy). Overall survival (OS), overall relapse rate (ORR), cumulative rate of local (CRLR), nodal (CRNR), and metastatic (CRMR) relapse, and their prognostic factors were retrospectively analyzed. Median follow-up was 77.5 months. Median OS was 41.7 ± 5.2 months. The 3-year ORR was 48%. Using univariate analysis ORR was significantly increased for patients with Siewert II/III compared to Siewert I tumors (27.3% versus 62%, p = 0.047). Siewert I tumors had also statistically lower CRNR and CRMR compared to Siewert II/III tumors (0/9.1% versus 41.3/60.2% resp., p = 0.012), despite an equivalent cumulative rate of local relapse and pathological complete response rate between the three groups. For OGJA treated with preoperative CRT and surgery, ORR and CRMR were lower for patients with Siewert I tumors in comparison with Siewert II/III tumors.

No MeSH data available.


Related in: MedlinePlus

Overall survival for overall population (a) and according to the Siewert classification (b).
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fig1: Overall survival for overall population (a) and according to the Siewert classification (b).

Mentions: Median follow-up was 77.5 months (range, 3–135 months). At the end of follow-up, 42 (61.8%) patients had died: 30 (44.1%) died of disease evolution, 7 (10.3%) patients died of treatment related complications including 5 (7.3%) patients who died in the two months following surgery, 3 patients (4.4%) died of other causes, and for 2 (2.9%) patients the cause of death was unknown. The 1- and 3-year OS rates were 80.8% and 57.2%, respectively, with a median of 41.7 ± 5.2 months (Figure 1(a)). Using univariate analysis, age as a continuous variable (p < 0.0001), tumor size as a continuous variable (p < 0.0001), Karnofsky performance status (p = 0.05), and ypN (p < 0.0001) classification significantly influenced OS. Using multivariate analysis, ypN status was the only factor independently influencing overall survival (p = 0.001). Results of uni- and multivariate analysis for OS are detailed in Table 4(a).


Impact of the Siewert Classification on the Outcome of Patients Treated by Preoperative Chemoradiotherapy for a Nonmetastatic Adenocarcinoma of the Oesophagogastric Junction.

Moureau-Zabotto L, Teissier E, Cowen D, Azria D, Ellis S, Resbeut M - Gastroenterol Res Pract (2015)

Overall survival for overall population (a) and according to the Siewert classification (b).
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4581544&req=5

fig1: Overall survival for overall population (a) and according to the Siewert classification (b).
Mentions: Median follow-up was 77.5 months (range, 3–135 months). At the end of follow-up, 42 (61.8%) patients had died: 30 (44.1%) died of disease evolution, 7 (10.3%) patients died of treatment related complications including 5 (7.3%) patients who died in the two months following surgery, 3 patients (4.4%) died of other causes, and for 2 (2.9%) patients the cause of death was unknown. The 1- and 3-year OS rates were 80.8% and 57.2%, respectively, with a median of 41.7 ± 5.2 months (Figure 1(a)). Using univariate analysis, age as a continuous variable (p < 0.0001), tumor size as a continuous variable (p < 0.0001), Karnofsky performance status (p = 0.05), and ypN (p < 0.0001) classification significantly influenced OS. Using multivariate analysis, ypN status was the only factor independently influencing overall survival (p = 0.001). Results of uni- and multivariate analysis for OS are detailed in Table 4(a).

Bottom Line: The 3-year ORR was 48%.Using univariate analysis ORR was significantly increased for patients with Siewert II/III compared to Siewert I tumors (27.3% versus 62%, p = 0.047).For OGJA treated with preoperative CRT and surgery, ORR and CRMR were lower for patients with Siewert I tumors in comparison with Siewert II/III tumors.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Therapy, Institut Paoli Calmettes, 232 boulevard de Sainte Marguerite, 13009 Marseille, France.

ABSTRACT
The aim of the study is to analyze the impact of the Siewert classification on the pathological complete response (pcR), pattern of failure, and general outcome of patients treated, by preoperative chemoradiotherapy and surgery for an gastroesophageal junction adenocarcinoma (OGJA). From 2000 to 2008, the charts of 68 patients were retrospectively reviewed. Tumor staging reported was UST1/T2/T3/T4/unknown, respectively, n = 1/7/54/5/1 patients, and N0/N1/unknown, respectively, n = 9/58/1 patients. Patients received primary external-beam radiotherapy with concurrent chemotherapy followed by surgical resection (Siewert I: upper oesogastrectomy; Siewert II/III: total gastrectomy with lower oesophagectomy). Overall survival (OS), overall relapse rate (ORR), cumulative rate of local (CRLR), nodal (CRNR), and metastatic (CRMR) relapse, and their prognostic factors were retrospectively analyzed. Median follow-up was 77.5 months. Median OS was 41.7 ± 5.2 months. The 3-year ORR was 48%. Using univariate analysis ORR was significantly increased for patients with Siewert II/III compared to Siewert I tumors (27.3% versus 62%, p = 0.047). Siewert I tumors had also statistically lower CRNR and CRMR compared to Siewert II/III tumors (0/9.1% versus 41.3/60.2% resp., p = 0.012), despite an equivalent cumulative rate of local relapse and pathological complete response rate between the three groups. For OGJA treated with preoperative CRT and surgery, ORR and CRMR were lower for patients with Siewert I tumors in comparison with Siewert II/III tumors.

No MeSH data available.


Related in: MedlinePlus