Outcomes of perioperative chemotherapy compared to preoperative chemoradiotherapy in esophagogastric adenocarcinoma: NCDB analysis

Information on real-world treatment patterns and outcomes in nonmetastatic esophagogastric adenocarcinoma (EGA) is limited. Analysis of the National Cancer Database compared outcomes of common treatments for nonmetastatic EGA. A total of 4715 patients were included. The median age was 63 years; 75.9% were male; 82.9% were non-Hispanic White; 47.5% had clinical stage III disease; 57.8% had regional lymph node involvement. Four groups were analyzed: (1) preoperative chemotherapy, (2) perioperative chemotherapy, (3) preoperative chemotherapy followed by chemoradiation, and (4) preoperative chemoradiotherapy. Median follow-up was 79.5 months. Patients who received perioperative chemotherapy had improved median overall survival compared with patients who received preoperative chemoradiotherapy (79.1 months versus 74.6 months; p<0.001). After adjustment for age, race, Charlson-Deyo score, facility type, year of diagnosis, involvement of regional lymph nodes, and clinical stage, the association remained statistically significant (HR 0.78; p=0.003). The authors conclude that in nonmetastatic EGA, perioperative chemotherapy is associated with better overall survival compared to preoperative chemotherapy.