Treatment Patterns for Gastroesophageal Junction Adenocarcinoma in the United States

Journal of Clinical Medicine

MarielaA. Blum¹  JafferA. Ajani¹  JeannelynS. Estrella²  BruceD. Minsky³  Prajnan Das³  PaulF. Mansfield⁴  BrianD. Badgwell⁴  BradfordJ. Kim⁴  Yi-Ju Chiang⁴  Ching-WeiD. Tzeng⁴  Naruhiko Ikoma⁴  WayneL. Hofstetter⁵ 

[1] Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Drive, Unit 1484, Houston, TX 77030, USA;Department of Pathology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Drive, Unit 1484, Houston, TX 77030, USA;Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Drive, Unit 1484, Houston, TX 77030, USA;Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Drive, Unit 1484, Houston, TX 77030, USA;Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, 1400 Pressler Drive, Unit 1484, Houston, TX 77030, USA;

关键词: chemoradiation;    esophagectomy;    gastrectomy;    GEJ;    neoadjuvant therapy;   

DOI  :  10.3390/jcm9113495

来源: DOAJ

【 摘 要 】

Despite the increasing incidence of gastroesophageal junction adenocarcinoma (GEJA), the optimal treatment strategy for the disease remains unknown. The objective of this study was to describe treatment patterns for GEJA in the United States. The National Cancer Database was searched to identify all patients who underwent resection of the lower esophagus, abdominal esophagus, and/or gastric cardia for GEJA between 2006 and 2016. Patients were grouped by clinical disease stage: early localized (L; T1-2N0), locally advanced (LA; T3-4N0), regional (R; T1-2N+), or regionally advanced (RA; T3-4N+). The search identified 28,852 GEJA patients. The dominant age range was 60–69 years (39%). Most patients were men (85%), and most were white (92%). Most L patients (69%) underwent upfront surgery, whereas most LA, R, and RA patients received neoadjuvant therapy (NAT; 86%, 80%, and 90%, respectively). Among patients who received NAT, 85% received chemoradiotherapy. Adjuvant therapy was relatively uncommon across all groups (15–20%). In the LA, R, and RA groups, overall survival was greater in patients who received NAT compared to upfront surgery (p < 0.001). With the exception of patients with early localized node-negative disease, most GEJA patients receive neoadjuvant chemoradiotherapy despite the lack of prospective trials reporting survival benefit over chemotherapy alone.

【 授权许可】

Unknown