title: Role of neoadjuvant treatment in clinical T2N0M0 oesophageal cancer: results from a retrospective multi-center European study.
abstract: OBJECTIVE
  The aims of this study were to compare short- and long-term outcomes for clinical T2N0 oesophageal cancer with analysis of (i) primary surgery (S) versus neoadjuvant therapy plus surgery (NS), (ii) squamous cell carcinoma and adenocarcinoma subsets; and (iii) neoadjuvant chemoradiotherapy versus neoadjuvant chemotherapy.
  
  
  METHODS
  Data were collected from 30 European centres from 2000 to 2010. Among 2944 included patients, 355 patients (12.1%) had cT2N0 disease; 285 (S) and 70 (NS), were compared in terms of short- and long-term outcomes. Propensity score matching analyses were used to compensate for differences in baseline characteristics.
  
  
  RESULTS
  No significant differences between the groups were shown in terms of in hospital morbidity and mortality. Nodal disease was observed in 50% of S-group at the time of surgery, with 20% pN2/N3. Utilisation of neoadjuvant therapy was associated with significant tumour downstaging as reflected by increases in pT0, pN0 and pTNM stage 0 disease, this effect was further enhanced with neoadjuvant chemoradiotherapy. After adjustment on propensity score and confounding factors, for all patients and subset analysis of squamous cell and adenocarcinoma, neoadjuvant therapy had no significant effect upon survival or recurrence (overall, loco-regional, distant or mixed) compared to surgery alone. There were no significant differences between neoadjuvant chemotherapy and chemoradiotherapy in short- or long-term outcomes.
  
  
  CONCLUSIONS
  The results of this study suggest that a surgery alone treatment approach should be recommended as the primary treatment approach for cT2N0 oesophageal cancer despite 50% of patients having nodal disease at the time of surgery.
authors.affiliation: Department of Surgery & Cancer, Imperial College, London, UK.
authors.forename: Sheraz R
authors.initials: SR
authors.lastname: Markar
authors.affiliation: Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, Lille, France; North of France University, Lille, France; Inserm UMR S-1172, Team 5 "Mucins, Epithelial Differenciation and Carcinogenesis", JPARC, Lille, France.
authors.forename: Caroline
authors.initials: C
authors.lastname: Gronnier
authors.affiliation: Department of Digestive Surgery of Edouard Herriot University Hospital, Lyon, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Pasquer
authors.affiliation: North of France University, Lille, France; SIRIC OncoLille, France; Department of Biostatistics, University Hospital, Lille, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Duhamel
authors.affiliation: North of France University, Lille, France; SIRIC OncoLille, France; Department of Biostatistics, University Hospital, Lille, France.
authors.forename: Hélène
authors.initials: H
authors.lastname: Beal
authors.affiliation: Cavale Blanche University Hospital, Brest, France.
authors.forename: Jérémie
authors.initials: J
authors.lastname: Théreaux
authors.affiliation: Estaing University Hospital, Clermont-Ferrand, France.
authors.forename: Johan
authors.initials: J
authors.lastname: Gagnière
authors.affiliation: Côte de Nacre University Hospital, Caen, France.
authors.forename: Gil
authors.initials: G
authors.lastname: Lebreton
authors.affiliation: Hautepierre University Hospital, Strasbourg, France.
authors.forename: Cécile
authors.initials: C
authors.lastname: Brigand
authors.affiliation: Pontchaillou University Hospital, Rennes, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Meunier
authors.affiliation: Haut-Levêque University Hospital, Bordeaux, France.
authors.forename: Denis
authors.initials: D
authors.lastname: Collet
authors.affiliation: Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, Lille, France; North of France University, Lille, France; Inserm UMR S-1172, Team 5 "Mucins, Epithelial Differenciation and Carcinogenesis", JPARC, Lille, France; SIRIC OncoLille, France. Electronic address: christophe.mariette@chru-lille.fr.
authors.forename: Christophe
authors.initials: C
authors.lastname: Mariette
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D059186:Chemoradiotherapy, Adjuvant / Q000009:adverse effects / Q000401:mortality; D017024:Chemotherapy, Adjuvant; D016009:Chi-Square Distribution; D018572:Disease-Free Survival; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D000077277:Esophageal Squamous Cell Carcinoma; D016629:Esophagectomy / Q000009:adverse effects / Q000401:mortality; D005060:Europe; D005260:Female; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000009:adverse effects / Q000401:mortality; D009367:Neoplasm Staging; D057216:Propensity Score; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Neoadjuvant treatment; Oesophageal cancer; Review; Surgery; Survival; cT2N0M0