Background/objectives: Improvements in esophageal adenocarcinoma (EAC) treatment have reduced mortality. While chemoradiation before surgery was previously a standard of care, updated guidelines recommend peri-operative chemotherapy without chemoradiation. Continued investigation into optimal non-operative treatment paradigms for patients who defer surgery or are not candidates for surgery and certain chemotherapy regimens is needed. The impact of induction chemotherapy prior to chemoradiation on survival and surgical outcomes remains unclear. This study assessed survival and surgical outcomes in a real-world cohort of EAC patients receiving induction chemotherapy before chemoradiation. Methods: This single-institution, IRB-approved, retrospective cohort study included patients with newly diagnosed stage II-IVb (oligometastatic for IVb) EAC who received definitive chemoradiation (radiation ≥ 40 Gy and two cycles of chemotherapy) +/− esophagectomy from 2007 to 2022. Patients receiving induction chemotherapy were compared to those who did not. Endpoints included survival and surgical outcomes. Results: A total of 141 EAC patients received definitive chemoradiation; 83 received induction chemotherapy before chemoradiation. Patients receiving induction chemotherapy were younger (p< 0.01) with slightly lower performance status (p= 0.27) and presented at a more advanced stage (p< 0.001). Median OS was 3.5 years in the induction chemotherapy group compared to 2.2 years (p= 0.10). There was no difference in pathologic complete response (p= 0.81), esophagectomy frequency (p= 0.87), or surgical downstaging between treatment groups (p= 0.84). Conclusions: In this real-world, single-institutional patient cohort investigating induction chemotherapy prior to chemoradiation in EAC, patients receiving induction chemotherapy did well but did not have a statistically significant improvement in survival outcomes or surgical outcomes. This study showed that significant numbers of real-world patients may not receive esophagectomy. Thus, prospective, randomized clinical trials are warranted to better delineate the efficacy and selection of patients for induction chemotherapy when non-operative approaches are favored.
背景/目标：食管腺癌（EAC）治疗方法的改进已降低死亡率。虽然手术前放化疗曾是标准治疗方案，但更新后的指南推荐采用围手术期化疗而不联合放化疗。对于推迟手术、不适合手术的患者及某些化疗方案，仍需持续研究其最佳非手术治疗模式。放化疗前诱导化疗对生存和手术结局的影响尚不明确。本研究评估了真实世界中接受放化疗前诱导化疗的EAC患者的生存及手术结局。
方法：这项经机构审查委员会批准的单中心回顾性队列研究纳入2007年至2022年新诊断的II-IVb期（IVb期为寡转移）EAC患者，所有患者均接受根治性放化疗（放疗≥40 Gy联合两周期化疗）+/−食管切除术。比较接受诱导化疗与未接受诱导化疗的患者。研究终点包括生存结局和手术结局。
结果：共有141例EAC患者接受根治性放化疗，其中83例在放化疗前接受诱导化疗。接受诱导化疗的患者更年轻（p<0.01）、体能状态稍差（p=0.27）且分期更晚（p<0.001）。诱导化疗组的中位总生存期为3.5年，未接受诱导化疗组为2.2年（p=0.10）。两组在病理完全缓解率（p=0.81）、食管切除术实施频率（p=0.87）及手术降期率（p=0.84）方面均无差异。
结论：在这项真实世界单中心队列研究中，对EAC患者放化疗前实施诱导化疗的观察显示，接受诱导化疗的患者虽有良好表现，但在生存结局或手术结局方面未取得统计学显著改善。研究表明真实世界中有大量患者可能未接受食管切除术。因此，有必要开展前瞻性随机临床试验，以在倾向非手术治疗时更清晰地界定诱导化疗的疗效及患者选择标准。
肿瘤(癌症)患者之家