Metastatic Gastroesophageal Adenocarcinoma Patients Treated with Systemic Therapy Followed by Consolidative Local Therapy: A Nomogram Associated with Long-Term Survivors.
OBJECTIVE
Patients with metastatic gastroesophageal adenocarcinoma (MGEAC) have a poor but heterogeneous clinical course. Some patients have an unusually favorable outcome. We sought to identify clinical variables associated with more favorable outcomes.


METHODS
Of 246 patients with MGEAC, we identified 64 who received systemic therapy and eventually received local consolidation therapy. Univariate and multivariate Cox regression models were used, and a nomogram was developed.


RESULTS
Of these 64 patients, 61% had received consolidation chemoradiation (CRT) with doses of 50-55 Gy and 78% did not undergo surgery. The median follow-up time of survivors was 3.9 years, and the median overall survival (OS) from CRT start was 1.5 years (95% CI, 1.2-2.2). Surgery (as local consolidation) was an independent prognosticator for longer OS in the multivariate analysis (p = 0.02). The 5-year OS rate was 25% (SE = 6%). The contributors to the nomogram were longer duration of systemic therapy before CRT and the type of local therapy.


CONCLUSIONS
Our data suggest that a subset of patients with MGEAC have an excellent prognosis (OS >5 years). However, these patients need to be identified during their clinical course so that local consolidation (CRT, surgery, or both) may be offered.
Department of Gastrointestinal Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Tex., USA.
Hironori
H
Shiozaki
Rebecca S
RS
Slack
Hsiang-Chun
HC
Chen
Elena
E
Elimova
Venkatram
V
Planjery
Nick
N
Charalampakis
Roopma
R
Wadhwa
Yusuke
Y
Shimodaira
Heath
H
Skinner
Jeffrey H
JH
Lee
Brian
B
Weston
Manoop S
MS
Bhutani
Mariela
M
Blum-Murphy
Jane E
JE
Rogers
Dipen M
DM
Maru
Aurelio
A
Matamoros
Tara
T
Sagebiel
Jeannelyn S
JS
Estrella
Prajnan
P
Das
Wayne L
WL
Hofstetter
Jeannette E
JE
Mares
Dilsa
D
Mizrak Kaya
Kazuto
K
Harada
Quan
Q
Lin
Bruce D
BD
Minsky
Brian D
BD
Badgwell
Jaffer A
JA
Ajani
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D004938:Esophageal Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D004943:Esophagogastric Junction / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D049451:Nomograms; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D011743:Pyrimidines / Q000008:administration & dosage; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D017741:Survivors; D043823:Taxoids / Q000008:administration & dosage
D009944:Organoplatinum Compounds; D011743:Pyrimidines; D043823:Taxoids