Adenokarzinom des ösophagogastralen Übergangs: Retrospektive Analyse von Therapieansätzen

Abstract

Background: The FLOT protocol and the CROSS trimodality regimen represent current standards in the management of locally advanced esophageal adenocarcinoma. In the absence of published Randomised Controlled Trial data, this propensity-matched comparison evaluated tolerance, toxicity, impact on sarcopenia and pulmonary physiology, operative complications, and oncologic metrics. Methods: Two hundred and twenty-two patients, 111 in each arm, were included from 2 high-volume centers. Computed tomography-measured sarcopenia, and pulmonary function (forced expiratory volume in first second/forced vital capacity/diffusion capacity for carbon monoxide) were compared pretherapy and posttherapy. Operative complications were defined as per the Esophageal Complications Consensus Group (ECCG) criteria, and severity per Clavien-Dindo. Tumor regression grade and R status were measured, and survival estimated per Kaplan-Meier. Results: A total of 83% were male, cT3/cN+ was 92%/68% for FLOT, and 86%/60% for CROSS. The full prescribed regimen was tolerated in 40% of FLOT patients versus 92% for CROSS. Sarcopenia increased from 16% to 33% for FLOT, and 14% to 30% in CROSS (P <0.01 between arms). Median decrease in diffusion capacity for carbon monoxide was -8.25% (-34 to 25) for FLOT, compared with -13.8% (-38 to 29), for CROSS (P = 0.01 between arms). Major pathologic response was 27% versus 44% for FLOT and CROSS, respectively (P = 0.03). In-hospital mortality, respectively, was 1% versus 2% (P = 0.9), and Clavien Dindo >III 22% versus 27% (P =0.59), however, respiratory failure was increased by CROSS, at 13% versus 3% (P <0.001). Three-year survival was similar at 63% (FLOT) and 60% (CROSS) (P =0.42).