Real-World Outcomes of Peri-Operative Chemotherapy With Fluorouracil, Leucovorin, Oxaliplatin, and Docetaxel in Upper Gastrointestinal Cancers: An Audit of Patients Diagnosed Between 2017 and 2020 at the Christie Hospital

Background Following the FLOT4 trial, perioperative chemotherapy with docetaxel, oxaliplatin, leucovorin, and 5-fluorouracil (FLOT) has been established as the global standard of care for resectable upper gastrointestinal (GI) adenocarcinomas. This retrospective audit aims to provide an insight into the real-world outcomes of this therapy for oesophageal, gastro-oesophageal junction (GOJ), and gastric cancers at the Christie Hospital, a tertiary cancer care centre. The main outcomes to be analysed include overall survival, progression-free survival, and evaluation of prognostic factors, including performance status, weight loss and lymphovascular invasion (LVI). Methods Patients with histologically confirmed oesophageal, GOJ, and gastric cancers with at least T2 status (or T1 with node involvement) and M0 were included. Data was collected retrospectively using electronic medical records. FLOT was given neo-adjuvantly as four cycles, followed by surgical resection and four cycles adjuvantly. Data was gathered regarding surgical outcomes (staging, regression, resection) and chemotherapy outcomes (dose reductions, deferrals, admissions, toxicities). Results Of the 285 patients, only 162 (56.8%) successfully commenced the adjuvant phase, highlighting significant treatment drop-off. By the date of censorship, 120 had progressed or died. While the median overall survival was not reached by the time of censorship, statistical analyses demonstrated stronger rates for those who had started adjuvant therapy. Progression-free survival at 24 months was 62.5% (n=178). Performance status and LVI were strong prognostic factors, with hazard ratios of 1.702 (95% CI 1.205-2.404, p=.003) and 5.138 (95% CI 3.111-8.484, p<.001), respectively. Weight loss also had a strong hazard ratio of 1.509, but was not statistically significant (p=0.91). Conclusion This institutional audit validates the substantial benefit of peri-operative FLOT in routine practice. Treatment completion is strongly associated with improved outcomes, though this is tempered by inherent selection bias. LVI and performance status are essential, quantifiable prognostic factors that should guide risk stratification and patient counseling. Strategies to improve adjuvant completion rates remain a critical clinical priority.