Comparison of Pretreatment Strategies for cT2cN0 Staged Adenocarcinoma of the Esophagus and the Gastroesophageal Junction: A European High-Volume Center Cohort Analysis

After the ESOPEC trial showed a survival benefit for fluorouracil, leucovorin, oxaliplatin, and docetaxel (FLOT)-treated adenocarcinomas of the esophagus (EAC) and the gastroesophageal junction (GEJ) compared with Chemoradiotherapy for Oesophageal Cancer Followed by Surgery Study (CROSS), a European, high-volume center study for stage cT2cN0 EAC and GEJ was undertaken, as it has been published that a third of these patients are understaged and could benefit from a multimodal approach PATIENTS AND METHODS: Retrospective analysis of prospective databases from ten high-volume European centers was performed. Inclusion criteria were GEJ Siewert type I/II or EAC with cT2cN0 status at diagnosis undergoing multimodal treatment with FLOT or CROSS. Primary endpoint was overall survival (OS) RESULTS: Between 2012 and 2023, 133 patients met the inclusion criteria, of whom 73 (54.9%) received CROSS and 60 (45.1%) underwent treatment with FLOT. In both groups, patients were mainly male (p = 0.08), older than 70 years (p = 0.24), and had American Society of Anesthesiologists (ASA) II classification (p = 0.45). Regarding surgical treatment, more patients underwent gastrectomy in the FLOT than in the CROSS cohort (23.3% versus 6.8%, p = 0.007). There were no differences regarding pT, pN, and pM category (p > 0.05). Median survival was not reached, while mean survival was 74.6 months (95% CI 60.5-88.7 months) for CROSS versus 100.8 months (95% CI 72.5-94.5 months, p = 0.028) for FLOT. The 3-year survival was 87% in the FLOT group versus 59% in the CROSS group. In multivariable analyses, FLOT was independent factor for survival (p < 0.001) CONCLUSIONS: For cT2cN0 staged EAC and GEJ type I /II patients FLOT chemotherapy showed a survival benefit and should be the preferred treatment in a multimodal approach.

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Journal
Annals of Surgical Oncology
Published
2025-10-13
DOI
https://doi.org/10.1245/s10434-025-18311-8
Citations
2
Primary Topic
Esophageal Cancer Research and Treatment
Type
article
Field-Weighted Citation Impact
4.01
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article

Comparison of Pretreatment Strategies for cT2cN0 Staged Adenocarcinoma of the Esophagus and the Gastroesophageal Junction: A European High-Volume Center Cohort Analysis

Naita M. Wirsik, Thomas Schmidt, Nerma Crnovrsanin, Cezanne D. Kooij et al.
2 citations
Annals of Surgical Oncology
Esophageal Cancer Research and Treatment
4.01
article

Comparison of Pretreatment Strategies for cT2cN0 Staged Adenocarcinoma of the Esophagus and the Gastroesophageal Junction: A European High-Volume Center Cohort Analysis

Naita M. Wirsik, Thomas Schmidt, Nerma Crnovrsanin, Cezanne D. Kooij, Niall Dempster, Mark I. van Berge Henegouwen, Noel E. Donlon, Henrik Nienhüser, Kunal Bhanot, Peter Grimminger, John V. Reynolds, Wolfgang P. Schröder, Suzanne Sarah Gisbertz, Daniela Polette, Richard van Hillegersberg, Christiane J. Bruns, Fredrik Klevebro, Florian Seyfried, Hans Friedrich Fuchs, Daniel Reim, Magnus Nilsson, Jelle P. H. Ruurda, Eren Uzun, Sheraz Markar, Kammy Kewani, Christoph-Thomas Germer
article en
2 citations

Abstract

After the ESOPEC trial showed a survival benefit for fluorouracil, leucovorin, oxaliplatin, and docetaxel (FLOT)-treated adenocarcinomas of the esophagus (EAC) and the gastroesophageal junction (GEJ) compared with Chemoradiotherapy for Oesophageal Cancer Followed by Surgery Study (CROSS), a European, high-volume center study for stage cT2cN0 EAC and GEJ was undertaken, as it has been published that a third of these patients are understaged and could benefit from a multimodal approach PATIENTS AND METHODS: Retrospective analysis of prospective databases from ten high-volume European centers was performed. Inclusion criteria were GEJ Siewert type I/II or EAC with cT2cN0 status at diagnosis undergoing multimodal treatment with FLOT or CROSS. Primary endpoint was overall survival (OS) RESULTS: Between 2012 and 2023, 133 patients met the inclusion criteria, of whom 73 (54.9%) received CROSS and 60 (45.1%) underwent treatment with FLOT. In both groups, patients were mainly male (p = 0.08), older than 70 years (p = 0.24), and had American Society of Anesthesiologists (ASA) II classification (p = 0.45). Regarding surgical treatment, more patients underwent gastrectomy in the FLOT than in the CROSS cohort (23.3% versus 6.8%, p = 0.007). There were no differences regarding pT, pN, and pM category (p > 0.05). Median survival was not reached, while mean survival was 74.6 months (95% CI 60.5-88.7 months) for CROSS versus 100.8 months (95% CI 72.5-94.5 months, p = 0.028) for FLOT. The 3-year survival was 87% in the FLOT group versus 59% in the CROSS group. In multivariable analyses, FLOT was independent factor for survival (p < 0.001) CONCLUSIONS: For cT2cN0 staged EAC and GEJ type I /II patients FLOT chemotherapy showed a survival benefit and should be the preferred treatment in a multimodal approach.

Annals of Surgical OncologyVol. 32(13)
Karolinska University Hospital (SE), Utrecht University (NL), Johannes Gutenberg University Mainz (DE), Trinity College Dublin (IE), Heidelberg University (DE), University Hospital Heidelberg (DE), Karolinska Institutet (SE), University Medical Center Utrecht (NL), University of Oxford (GB), University Medical Center of the Johannes Gutenberg University Mainz (DE), Universitätsklinikum Würzburg (DE), Amsterdam University Medical Centers (NL), University Hospital Cologne (DE), St. James's Hospital (IE), Technical University of Munich (DE), University of Amsterdam (NL)
Openalex Percentile: Top 6%
Esophageal Cancer Research and Treatment
4.01
DOIOpen Access PDFOpenAlex
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