Cancer. 2026 Aug 15;132(16):e70571. doi: 10.1002/cncr.70571.
ABSTRACT
BACKGROUND: Nonmetastatic esophagogastric adenocarcinoma require multimodal treatment for management. However, real-world treatment patterns and outcomes in these patients are limited. We evaluated the survival outcomes associated with the common treatment combinations in the National Cancer Database.
METHODS: A total of 4715 patients met the predefined inclusion and exclusion criteria. Four groups were created: group 1, preoperative chemotherapy; group 2, perioperative chemotherapy; group 3, preoperative chemotherapy followed by chemoradiation; and group 4, preoperative chemoradiotherapy. Kaplan-Meier curves were used to assess overall survival. Cox proportional hazard regression estimated hazard ratios (HR) and 95% CIs for associations between covariates and overall survival. Inverse probability of treatment weighting based on propensity scores were used to account for differences in baseline characteristics between treatment groups.
RESULTS: The median age was 63 years; 75.9% were male and 82.9% were non-Hispanic White; overall, 47.5% had clinical stage III disease and 57.8% had regional lymph node involvement. Median follow-up was 79.5 months. Patients who received perioperative chemotherapy had improved median overall survival compared with patients who received preoperative chemoradiotherapy (79.1 vs 74.6 months; p < .001). After adjustment for age, race, Charlson-Deyo Score, facility type, year of diagnosis, presence of regional lymph nodes, clinical stage, the association remained statistically significant (HR = 0.78; 95% CI, 0.66-0.92; p = .003).
CONCLUSION: Although several multimodality treatment strategies are used for esophagogastric adenocarcinoma, perioperative chemotherapy is associated with better overall survival compared to preoperative chemoradiotherapy.
PMID:42603143 | DOI:10.1002/cncr.70571
