Neoadjuvant Chemotherapy Improves Survival Over Chemoradiation in Esophageal Cancer
A new analysis of data from the US National Cancer Database (NCDB) reveals that neoadjuvant chemotherapy (NCT) is associated with significantly improved overall survival (OS) compared to neoadjuvant chemoradiation (NCRT) in patients undergoing esophagectomy for esophageal adenocarcinoma (EAC). These findings challenge the current standard of care and suggest a potential paradigm shift in the treatment of operable EAC.
Researchers retrospectively examined outcomes for patients with EAC who received multiagent NCT vs NCRT prior to surgery. Using propensity score matching to correct for baseline differences, researchers analyzed 1007 patients in each treatment cohort. Both groups were well-matched in demographics and clinical characteristics, including age, gender, T/N stage, tumor grade, and treatment center volume.
While patients in the NCRT group demonstrated superior rates of R0 resection and pathologic response, the NCT group achieved significantly better survival outcomes. Median OS was 42.7 months in the NCT group vs 34.2 months in the NCRT group (P = .001). Five-year survival rates were also higher in the NCT cohort (42% vs 35%). Among patients who achieved a pathologic complete response, median survival reached 101 months with NCT, compared to 71.2 months for those receiving NCRT (P = .04).
Multivariate analysis identified several predictors of improved mortality, including female gender, nodal clearance (pN0), extensive lymphadenectomy (> 10 nodes removed), pathologic response, R0 resection, well/moderate tumor grade, use of adjuvant chemotherapy, and treatment at high-volume centers. Notably, there was no survival benefit to adjuvant chemoradiation.
The authors conclude that despite better pathologic outcomes with NCRT, neoadjuvant chemotherapy leads to superior long-term survival and warrants reevaluation as the preferred neoadjuvant strategy for operable EAC. Further prospective trials may help refine treatment guidelines.
Reference
Shridhar R, Meredith K, Huston J. Outcomes of neoadjvuant chemotherapy versus chemoradiation for esophageal adenocarcinoma: A National Cancer Database analysis. Presented at the 2025 ASCO Gastrointestinal Cancers Symposium; January 23-January 25, 2025. San Francisco, CA.
