Background:The management of localized esophageal and esophagogastric junction (EGJ) adenocarcinomas remains challenging. Although perioperative chemotherapy with the fluorouracil, leucovorin, oxaliplatin, and docetaxel (FLOT) regimen or preoperative concurrent chemoradiotherapy with carboplatin and paclitaxel (CROSS) regimen followed by surgery are standard options, the optimal approach is still debated. This study evaluated real-world outcomes of perioperative FLOT versus preoperative CROSS in such patients.Methods:A retrospective cohort study was conducted at a tertiary cancer center in Australia, including patients treated with FLOT or CROSS between 2014 and 2024. Multivariate Cox regression models adjusted for baseline differences, including demographics, tumor stage, differentiation, location, and surgical resection.Results:Among 70 patients, 15 received FLOT and 55 received CROSS. Median overall survival (OS) was 30.3 months for FLOT and 37.5 months for CROSS (p= 0.75). Median event-free survival (EFS) was not reached in the FLOT group and was 14.8 months in the CROSS group (p= 0.49). After multivariate adjustment, differences in OS and EFS were not significant. Compared to FLOT, CROSS was associated with higher treatment completion and response rates. CROSS also led to greater pathological tumor and nodal downstaging, as well as higher rates of complete pathological response.Conclusions:Both FLOT and CROSS appear to be effective treatment options for localized esophageal and EGJ adenocarcinomas. CROSS may offer advantages in terms of treatment tolerability and tumor response, and may be particularly suitable for patients with bulky tumors or reduced performance status. Owing to the limited sample size and follow-up, these findings should be interpreted cautiously. Personalized treatment decisions should be guided by multidisciplinary discussions, considering tumor characteristics, patient condition, and access to adjuvant immunotherapy.
背景：局限性食管及食管胃结合部腺癌的治疗仍具挑战。尽管氟尿嘧啶、亚叶酸、奥沙利铂联合多西他赛方案围手术期化疗或卡铂联合紫杉醇方案术前同步放化疗后手术是标准选择，但最佳治疗方案仍存争议。本研究评估了此类患者围手术期FLOT方案与术前CROSS方案在真实世界中的疗效差异。 方法：在澳大利亚某三级癌症中心开展回顾性队列研究，纳入2014年至2024年间接受FLOT或CROSS方案治疗的患者。通过多变量Cox回归模型校正基线差异，包括人口统计学特征、肿瘤分期、分化程度、病灶位置及手术切除情况。 结果：70例患者中，15例接受FLOT方案，55例接受CROSS方案。FLOT组中位总生存期为30.3个月，CROSS组为37.5个月（p=0.75）。FLOT组中位无事件生存期未达到，CROSS组为14.8个月（p=0.49）。经多变量校正后，两组总生存期和无事件生存期差异均无统计学意义。与FLOT方案相比，CROSS方案治疗完成率和应答率更高，且在肿瘤病理降期、淋巴结降期及病理完全缓解率方面表现更优。 结论：FLOT与CROSS方案均为局限性食管及食管胃结合部腺癌的有效治疗选择。CROSS方案在治疗耐受性和肿瘤应答方面可能更具优势，尤其适用于肿瘤负荷较大或体能状态较差的患者。由于样本量有限且随访时间不足，需谨慎解读本研究结果。建议通过多学科讨论指导个体化治疗决策，综合考虑肿瘤特征、患者状况及辅助免疫治疗的可及性。
肿瘤(癌症)患者之家