title: Perioperative platin-based chemotherapy for locally advanced esophagogastric adenocarcinoma: Postoperative chemotherapy has a substantial impact on outcome.
abstract: BACKGROUND
  A combination of platin-based perioperative chemotherapy (PBPC) plus surgical resection has become the standard of care in Europe for locally advanced esophagogastric adenocarcinoma (EGAC). In contrast to preoperative chemotherapy, the postoperative administration of chemotherapy is omitted in a high percentage of patients. We conducted this database study to analyse the impact of postoperative completion of perioperative chemotherapy on patient outcome.
  
  
  METHODS
  Patients with EGAC (cT3-4 and/or cN+) were treated with preoperative PBPC plus curative surgical resection. Patient demographics, postoperative tumour stages, histopathological regression (HPR) and administration of postoperative chemotherapy were correlated with overall survival.
  
  
  RESULTS
  Of one-hundred-thirty-four patients, 76 received preoperative docetaxel, folinic acid, fluorouracil, oxaliplatin (FLOT), 53 patients epirubicin, cisplatin, folinic acid (ECF) and 5 epirubicin, oxaliplatin, capecitabine (EOX) chemotherapy. The 5-year-survival for the whole collective was 58%. Designated postoperative chemotherapy was omitted in 36% of the patients. 5-year-survival was 75.8% in patients who received pre- and post-operative chemotherapy and 40.3% in patients with only preoperative chemotherapy (p < 0.001). Histopathological regression, postoperative nodal status and administration of postoperative chemotherapy were identified as independent prognostic factors. Analysis of subgroups revealed a pronounced survival benefit after administration of postoperative chemotherapy in patients with ypN+ stages (5-year-survival 64.5% vs 9.7%, p = 0.002) and poor HPR (5-year-survival 55.5% vs 19.3%, p = 0.015).
  
  
  CONCLUSIONS
  Our study provides further evidence that administration of postoperative chemotherapy may contribute to the achieved survival benefit of PBPC in patients with EGAC and implies a beneficial effect especially in presence of lymphonodular tumour involvement and limited HPR.
authors.affiliation: Department of General Surgery, University Hospital Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Glatz
authors.affiliation: Department of Pathology, University Hospital Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Bronsert
authors.affiliation: Department of General Surgery, University Hospital Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Schäfer
authors.affiliation: Department of General Surgery, University Hospital Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Kulemann
authors.affiliation: Department of General Surgery, University Hospital Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Marjanovic
authors.affiliation: Department of General Surgery, University Hospital Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany.
authors.forename: O
authors.initials: O
authors.lastname: Sick
authors.affiliation: Department of General Surgery, University Hospital Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany.
authors.forename: U T
authors.initials: UT
authors.lastname: Hopt
authors.affiliation: Department of Medical Oncology, University Hospital Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Zirlik
authors.affiliation: Department of General Surgery, University Hospital Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Makowiec
authors.affiliation: Department of General Surgery, University Hospital Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany. Electronic address: jens.hoeppner@uniklinik-freiburg.de.
authors.forename: J
authors.initials: J
authors.lastname: Hoeppner
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D000069287:Capecitabine / Q000008:administration & dosage; D017024:Chemotherapy, Adjuvant / Q000379:methods; D002945:Cisplatin / Q000008:administration & dosage; D016208:Databases, Factual; D000077143:Docetaxel; D015251:Epirubicin / Q000008:administration & dosage; D004938:Esophageal Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D016629:Esophagectomy; D004943:Esophagogastric Junction / Q000473:pathology; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005743:Gastrectomy; D006801:Humans; D053208:Kaplan-Meier Estimate; D002955:Leucovorin / Q000008:administration & dosage; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D000077150:Oxaliplatin; D011184:Postoperative Period; D011446:Prospective Studies; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D043823:Taxoids / Q000008:administration & dosage; D016896:Treatment Outcome
chemical_list: D009944:Organoplatinum Compounds; D043823:Taxoids; D000077150:Oxaliplatin; D000077143:Docetaxel; D015251:Epirubicin; D000069287:Capecitabine; D002945:Cisplatin; D002955:Leucovorin; D005472:Fluorouracil
keywords: Adenocarcinoma; Adjuvant chemotherapy; Esophageal cancer; Gastric cancer; Histopathological regression; Perioperative chemotherapy