Preoperative Chemoradiation Versus Chemotherapy in Gastroesophageal Junction Adenocarcinoma

Background: The incidence of lower esophageal and gastroesophageal junction adenocarcinoma has sharply increased over the past several decades and is a serious public health problem. Preoperative therapy with either chemotherapy or chemoradiation is recommended, but the optimal regimen is unknown. We used the National Cancer Database and propensity score matching to investigate whether preoperative chemoradiation therapy offers an advantage over chemotherapy alone for patients with these tumors. Methods: From the National Cancer Database esophageal and gastric dataset, we selected patients with either lower esophageal or gastric cardia adenocarcinomas who had undergone definitive resection after chemotherapy or chemoradiation. We used propensity score matching to balance groups based on the preoperative treatment they received. We then used conditional multivariable logistic regression and Cox proportional hazard models to examine the association between preoperative therapy regimen and pathological response, overall survival (OS), and postoperative outcomes. Results: Our study included 13,783 patients; 12,129 (89.0%) had received preoperative chemoradiation. Propensity score matching created 1650 pairs. Patients receiving chemoradiation were 2.7 (95% confidence interval, 1.29-3.23) times more likely to achieve complete response in the primary tumor than were those receiving chemotherapy alone; however, chemoradiation was not associated with improved OS (hazard ratio, 1.01; 95% confidence interval, 0.91-1.12). Short-term outcomes (length of stay, mortality, and readmissions) were similar between the 2 groups. Conclusions: Preoperative chemoradiation was associated with a higher complete response rate in the primary tumor but not with improved OS in lower esophageal and gastroesophageal junction adenocarcinoma.