TY - JOUR
T1 - Delayed Surgical Intervention After Chemoradiotherapy in Esophageal Cancer
T2 - (DICE) Study
AU - Chidambaram, Swathikan
AU - Owen, Richard
AU - Sgromo, Bruno
AU - Chmura, Magdalena
AU - Kisiel, Aaron
AU - Evans, Richard
AU - Griffiths, Ewen A.
AU - Castoro, Carlo
AU - Gronnier, Caroline
AU - Maoawyes, Mometo Ali
AU - Gutschow, Christian A.
AU - Piessen, Guillaume
AU - Degisors, Sébastien
AU - Alvieri, Rita
AU - Feldman, Hope
AU - Capovilla, Giovanni
AU - Grimminger, Peter P.
AU - Han, Shiwei
AU - Low, Donald E.
AU - Moore, Jonathan
AU - Gossage, James
AU - Voeten, Dan
AU - Gisbertz, Suzanne S.
AU - Ruurda, Jelle
AU - Van Hillegersberg, Richard
AU - D'Journo, Xavier B.
AU - Chmelo, Jakub
AU - Phillips, Alexander W.
AU - Rosati, Riccardo
AU - Hanna, George B.
AU - Maynard, Nick
AU - Hofstetter, Wayne
AU - Ferri, Lorenzo
AU - Berge Henegouwen, Mark I.
AU - Markar, Sheraz R.
N1 - Publisher Copyright:
© 2023 Lippincott Williams and Wilkins. All rights reserved.
PY - 2023/11/1
Y1 - 2023/11/1
N2 - Objective: To determine the impact of delayed surgical intervention following chemoradiotherapy (CRT) on survival from esophageal cancer. Background: CRT is a core component of multimodality treatment for locally advanced esophageal cancer. The timing of surgery following CRT may influence the probability of performing an oncological resection and the associated operative morbidity. Methods: This was an international, multicenter, cohort study, including patients from 17 centers who received CRT followed by surgery between 2010 and 2020. In the main analysis, patients were divided into 4 groups based upon the interval between CRT and surgery (0-50, 51-100, 101-200, and >200 days) to assess the impact upon 90-day mortality and 5-year overall survival. Multivariable logistic and Cox regression provided hazard ratios (HRs) with 95% CIs adjusted for relevant patient, oncological, and pathologic confounding factors. Results: A total of 2867 patients who underwent esophagectomy after CRT were included. After adjustment for relevant confounders, prolonged interval following CRT was associated with an increased 90-day mortality compared with 0 to 50 days (reference): 51 to 100 days (HR=1.54, 95% CI: 1.04-2.29), 101 to 200 days (HR=2.14, 95% CI: 1.37-3.35), and >200 days (HR=3.06, 95% CI: 1.64-5.69). Similarly, a poorer 5-year overall survival was also observed with prolonged interval following CRT compared with 0 to 50 days (reference): 101 to 200 days (HR=1.41, 95% CI: 1.17-1.70), and >200 days (HR=1.64, 95% CI: 1.24-2.17). Conclusions: Prolonged interval following CRT before esophagectomy is associated with increased 90-day mortality and poorer long-term survival. Further investigation is needed to understand the mechanism that underpins these adverse outcomes observed with a prolonged interval to surgery.
AB - Objective: To determine the impact of delayed surgical intervention following chemoradiotherapy (CRT) on survival from esophageal cancer. Background: CRT is a core component of multimodality treatment for locally advanced esophageal cancer. The timing of surgery following CRT may influence the probability of performing an oncological resection and the associated operative morbidity. Methods: This was an international, multicenter, cohort study, including patients from 17 centers who received CRT followed by surgery between 2010 and 2020. In the main analysis, patients were divided into 4 groups based upon the interval between CRT and surgery (0-50, 51-100, 101-200, and >200 days) to assess the impact upon 90-day mortality and 5-year overall survival. Multivariable logistic and Cox regression provided hazard ratios (HRs) with 95% CIs adjusted for relevant patient, oncological, and pathologic confounding factors. Results: A total of 2867 patients who underwent esophagectomy after CRT were included. After adjustment for relevant confounders, prolonged interval following CRT was associated with an increased 90-day mortality compared with 0 to 50 days (reference): 51 to 100 days (HR=1.54, 95% CI: 1.04-2.29), 101 to 200 days (HR=2.14, 95% CI: 1.37-3.35), and >200 days (HR=3.06, 95% CI: 1.64-5.69). Similarly, a poorer 5-year overall survival was also observed with prolonged interval following CRT compared with 0 to 50 days (reference): 101 to 200 days (HR=1.41, 95% CI: 1.17-1.70), and >200 days (HR=1.64, 95% CI: 1.24-2.17). Conclusions: Prolonged interval following CRT before esophagectomy is associated with increased 90-day mortality and poorer long-term survival. Further investigation is needed to understand the mechanism that underpins these adverse outcomes observed with a prolonged interval to surgery.
KW - chemoradiotherapy
KW - esophageal cancer
KW - esophagectomy
KW - salvage esophagectomy
UR - http://www.scopus.com/inward/record.url?scp=85174640682&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85174640682&partnerID=8YFLogxK
U2 - 10.1097/SLA.0000000000006028
DO - 10.1097/SLA.0000000000006028
M3 - Article
C2 - 37477039
AN - SCOPUS:85174640682
SN - 0003-4932
VL - 278
SP - 701
EP - 708
JO - Annals of surgery
JF - Annals of surgery
IS - 5
ER -