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Primary Tumor Location Is a Predictor of Poor Prognosis in Patients with Locally Advanced Esophagogastric Cancer Treated with Perioperative Chemotherapy

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Abstract

Background

Esophagogastric cancer (EGC) is a leading neoplasm worldwide. Perioperative chemotherapy (periCT) is currently a standard of care for most patients (pts). Prevalence of esophagogastric junction (EGJ) tumors is increasing over the last years.

Methods

The aim of this study was to retrospectively search for prognostic factors in pts. with locally advanced EGC treated with periCT. Three-year overall survival (OS) and Event-Free Survival (EFS) were main end-points. HER-2 positive tumors were defined by immunohistochemistry or FISH.

Results

Between June/2007 and November/2015, 128 pts. started periCT for esophagogastric junction (EGJ) or gastric adenocarcinoma (GC). Median age was 59.5 y and 64% were male. Primary site was EGJ in 27% and 65% were cN+. Diffuse subtype was seen in 42%. Ninety-seven pts. were assessed for HER-2; 14 (14.4%) were positive. After median follow-up time of 45 m, 48 deaths occurred. The 3-year OS and EFS rate was 61.3% and 51.2%, respectively. Main prognostic factors were: AJCC ypT3-T4yN1-N3 (HR 6.75 p 0.002) and EGJ primary (HR 2.64, p 0.004). Overall HER-2 was not prognostic. Still, a difference in 3-year OS was observed for GC/HER2+ compared to EGJ/HER2+ (88.9% versus 20%, p = 0.002). This difference is greater for 3-year EFS with no patient with EGJ/HER2+ free-of-event against 62.5% for GC/HER+ (p = 0.011).

Conclusion

In our analysis, pathological staging and primary site were main prognostic factors. Moreover, a small group of EGJ/HER2+ had very poor survival.

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Authors and Affiliations

  1. Medical Oncology Department, AC Camargo Cancer Center, Rua Professor Antônio Prudente 211, Liberdade, São Paulo, SP CEP: 01509-010, Brazil

    Tiago Cordeiro Felismino, Audrey Cabral Ferreira de Oliveira, Ana Caroline Fonseca Alves, Rachel P. Riechelmann, Victor Hugo Fonseca de Jesus & Celso Abdon Lopes de Mello

  2. Surgical Oncology Departament, AC Camargo Cancer Center, São Paulo, Brazil

    Wilson Luiz da Costa Junior & Felipe José Fernadez Coimbra

  3. Pathology Departament, AC Camargo Cancer Center, São Paulo, Brazil

    Maria Dirlei Ferreira de Souza Begnami

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  1. Tiago Cordeiro Felismino
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Felismino, T.C., de Oliveira, A.C.F., Alves, A.C.F. et al. Primary Tumor Location Is a Predictor of Poor Prognosis in Patients with Locally Advanced Esophagogastric Cancer Treated with Perioperative Chemotherapy. J Gastrointest Canc 51, 484–490 (2020). https://doi.org/10.1007/s12029-019-00258-1

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