Outcomes and survival following neoadjuvant chemotherapy versus neoadjuvant chemoradiotherapy for cancer of the esophagus: inverse propensity score weighted analysis
Outcomes and survival following neoadjuvant chemotherapy versus neoadjuvant chemoradiotherapy for cancer of the esophagus: inverse propensity score weighted analysis
Background: esophageal cancer is increasingly common and carries a poor prognosis. The optimal treatment modality for locally advanced cancer is unknown, with current guidance recommending either neoadjuvant chemotherapy (CT) or chemoradiotherapy (CRT) followed by surgery. There is a lack of adequately powered trials comparing CT against CRT. We retrospectively compared CT versus CRT using a propensity score weighting approach.
Methods: demographic, disease, treatment and outcome data were retrieved from a local database for patients who received neoadjuvant CT or CRT followed by surgery. Inverse probability of treatment weighting (IPTW) was used to balance groups using a propensity score-weighting approach. Groups were assessed for differences in postoperative outcomes and survival. Kaplan-Meier and non-parametric tests were used to compare survival and outcome data as appropriate.
Results: data for 284 patients were retrieved. Following IPTW groups were well matched. No significant differences were seen for postoperative complications (CT 64.9% vs. CRT 63.3%, p=0.807), including major complications (24.0% vs. 23.6%, p=0.943) and anastomotic leak (7.8% vs. 5.6%, p=0.526). Significantly higher rates of clinical regression and complete pathological response were seen following CRT (p=0.002 for both). Rates of R0 resection were higher with CRT, CT 79.1% vs. CRT 93.1%, p=0.006. There was no difference between groups for overall or disease-free survival.
Conclusion: this study suggests that the significant improvements in local tumour response seen after neoadjuvant CRT compared to CT may not translate to different survival outcomes. However, it must be stressed that adequately powered prospective trials are sti
2248-2256
Pucher, Philip H.
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Rahman, Saqib
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Walker, Robert
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Grace, Ben L.
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Bateman, Andrew
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Iveson, Timothy
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Rees, Charlotte
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Byrne, James
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Kelly, Jamie
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Noble, Fergus
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Underwood, Timothy
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1 December 2020
Pucher, Philip H.
6b51dabb-77c2-40c6-bfa7-1daa3f82c0a6
Rahman, Saqib
e2b565d4-df7f-4496-8cc3-80fc63a9e4cd
Walker, Robert
c8fbfe1c-349d-497f-b24e-0295c84c4634
Grace, Ben L.
1d477b43-87f8-461f-ba91-782c37cd1837
Bateman, Andrew
a851558d-8b9b-4020-b148-a239c2b26815
Iveson, Timothy
867cb6c5-ea9a-4521-a4cc-4cd4d2503b3a
Rees, Charlotte
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Byrne, James
e3d5b8fe-1b69-441c-a173-e084fe5372a6
Kelly, Jamie
c8b841fe-7134-4332-b453-5dc8c76058a5
Noble, Fergus
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Underwood, Timothy
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Pucher, Philip H., Rahman, Saqib, Walker, Robert, Grace, Ben L., Bateman, Andrew, Iveson, Timothy, Rees, Charlotte, Byrne, James, Kelly, Jamie, Noble, Fergus and Underwood, Timothy
(2020)
Outcomes and survival following neoadjuvant chemotherapy versus neoadjuvant chemoradiotherapy for cancer of the esophagus: inverse propensity score weighted analysis.
European Journal of Surgical Oncology, 46 (12), .
(doi:10.1016/j.ejso.2020.06.038).
Abstract
Background: esophageal cancer is increasingly common and carries a poor prognosis. The optimal treatment modality for locally advanced cancer is unknown, with current guidance recommending either neoadjuvant chemotherapy (CT) or chemoradiotherapy (CRT) followed by surgery. There is a lack of adequately powered trials comparing CT against CRT. We retrospectively compared CT versus CRT using a propensity score weighting approach.
Methods: demographic, disease, treatment and outcome data were retrieved from a local database for patients who received neoadjuvant CT or CRT followed by surgery. Inverse probability of treatment weighting (IPTW) was used to balance groups using a propensity score-weighting approach. Groups were assessed for differences in postoperative outcomes and survival. Kaplan-Meier and non-parametric tests were used to compare survival and outcome data as appropriate.
Results: data for 284 patients were retrieved. Following IPTW groups were well matched. No significant differences were seen for postoperative complications (CT 64.9% vs. CRT 63.3%, p=0.807), including major complications (24.0% vs. 23.6%, p=0.943) and anastomotic leak (7.8% vs. 5.6%, p=0.526). Significantly higher rates of clinical regression and complete pathological response were seen following CRT (p=0.002 for both). Rates of R0 resection were higher with CRT, CT 79.1% vs. CRT 93.1%, p=0.006. There was no difference between groups for overall or disease-free survival.
Conclusion: this study suggests that the significant improvements in local tumour response seen after neoadjuvant CRT compared to CT may not translate to different survival outcomes. However, it must be stressed that adequately powered prospective trials are sti
Text
CRT v CT paper final_rev2_no track changes
- Accepted Manuscript
More information
Accepted/In Press date: 22 June 2020
e-pub ahead of print date: 10 July 2020
Published date: 1 December 2020
Identifiers
Local EPrints ID: 442032
URI: http://eprints.soton.ac.uk/id/eprint/442032
ISSN: 0748-7983
PURE UUID: 15734f11-f7cc-47ff-9680-8b9f2cc1e5a2
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Date deposited: 06 Jul 2020 16:30
Last modified: 17 Mar 2024 05:41
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Author:
Philip H. Pucher
Author:
Saqib Rahman
Author:
Robert Walker
Author:
Ben L. Grace
Author:
Andrew Bateman
Author:
Charlotte Rees
Author:
James Byrne
Author:
Jamie Kelly
Author:
Fergus Noble
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