Does perioperative FLOT increase cure rates in resectable esophageal adenocarcinoma? A mixture cure model analysis
Year: 2025
Type: article
Abstract: BACKGROUND: Translating trial findings to real-world cure rates for resectable oesophageal and gastroesophageal junction (GEJ) adenocarcinoma is critical. Standard endpoints like disease-free survival (DFS) may not distinguish durable cures from delayed recurrences. METHODS: This analysis of the AGAMENON-SEOM registry (NCT04958720) compared perioperative chemotherapy versus neoadjuvant chemoradiotherapy (nCRT). We estimated cure rates and analysed DFS and overall survival (OS) using mixture cure models and Cox proportional hazards models. RESULTS: In 500 patients, perioperative FLOT improved DFS (HR 0.60; p = 0.01) and OS (adjusted HR 0.63; p = 0.015) compared to CROSS-based nCRT. Notably, cure models confirmed a higher cure fraction for FLOT in high-risk subgroups (e.g., stage III, high neutrophil-to-lymphocyte ratio). While platinum-fluoropyrimidine-based nCRT ± immunotherapy yielded higher R0 and pathological complete response rates, its estimated cure rate was comparable to FLOT, both overall and across all subgroups. CONCLUSION: Cure is an informative endpoint in localised oesophageal cancer. In this registry analysis, perioperative FLOT was associated with higher cure rates than CROSS, particularly in high-risk subgroups. Exploratory findings suggest that alternative neoadjuvant strategies, such as those incorporating ICIs or FOLFOX, warrant further investigation.
Source: British Journal of Cancer
Authors: Lucía Mateos, Paula Jiménez-Fonseca, Javier Gallego, Arturo Lecumberri, Ana Custodio, Eva Martínez de Castro, Raquel Hernández San Gil, Ana Fernández Montes, María Luisa Limón, Rosario Vidal-Tocino, Juana María Cano, Javier López Robles, Mireia Gil, Daniel Acosta Eyzaguirre, Gema Marín Zafra, Antonio José Mérida-García, Alejandro Francisco Fernández, Paula Ribera Fernández, Cinta Hierro, María Carmen Riesco, Montse García Araque, Maribel Ruiz Martín, Paola Pimentel, Laura Visa, Paula Cerdá, Mónica Granja, Ana Belén Rupérez Blanco, Lourdes Gutiérrez, Alberto Carmona-Bayonas
Institutions: Universidad de Valladolid, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias, Hospital General Universitario de Elche, Navarre Institute of Health Research, Navarrabiomed, Hospital Universitario La Paz, Centro de Investigación Biomédica en Red de Cáncer, Marqués de Valdecilla University Hospital, Instituto de Investigación Marqués de Valdecilla, Hospital Universitario de Canarias, Complejo Hospitalario de Ourense, Hospital Universitario Virgen del Rocío, Complejo Hospitalario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Hospital General Universitario de Ciudad Real, Hospital General Universitario Morales Meseguer, Instituto Murciano de Investigación Biosanitaria, Universidad de Murcia, Hospital Clínico Universitario de Valencia, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institute of Oncology, Hospital Universitario Virgen de la Arrixaca, Complejo Hospitalario de Pontevedra, Corporació Sanitària Parc Taulí, Institute of Research and Innovation Parc Tauli, Institut Català d'Oncologia, Hospital Universitario 12 De Octubre, Hospital General Universitario de Alicante Doctor Balmis, Complejo Asistencial Universitario de Palencia, Santa Lucía University General Hospital, Hospital Del Mar, Hospital de Sant Pau, Hospital Clínico San Carlos, Hospital Universitario de Toledo, Hospital Universitario Puerta de Hierro Majadahonda
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $5,190
OpenAlex ID: W4416673855