Pathological complete response (pCR) after neoadjuvant chemotherapy (nCT) or neoadjuvant chemoradiotherapy (nCRT) for esophageal adenocarcinoma: a comparison of overall survival (OS) and recurrence-free survival (RFS). Several previous studies comparing nCT and nCRT found no differences in survival. However, the greater rate of pCR following nCRT has been proposed as the cause for selecting this modality over nCT. Researchers analyzed information from 8 intensive care facilities in a global cohort study. Patients with esophageal adenocarcinoma who had nCT or nCRT and achieved a pCR were considered for inclusion. Univariate analysis compared demographic characteristics, and 5-year OS and RFS were compared using Kaplan-Meier survival analysis. A total of 465 patients who achieved pCR after neoadjuvant treatment were analyzed, of whom 132 were given nCT and 333 were given nCRT. Comparison of 5-year OS between the 2 groups showed no statistically significant difference (78.8% (nCT) vs. 65.5% (nCRT), P=0.099); multivariate analysis showed a similar outcome, with an HR=1.19 and a 95% CI 0.77-1.84). Those who achieved a pCR after neoadjuvant chemoradiotherapy had a significantly lower 5-year RFS (75.3% (nCRT) vs 87.1% (nCT), P=0.026). The multivariate analysis showed that nCRT was linked to a lower 5-year RFS (HR=1.70, 95% CI 1.22-2.99). The 5-year rates of distant recurrence after nCRT were considerably higher (odds ratio=2.50, 95% CI 1.25-4.99). This multinational cohort study shows that the prognosis of pCR varies between neoadjuvant regimens, calling into doubt the utility of this metric as an oncological surrogate for comparing different approaches to treating esophageal cancer.
