PD04.07. Efficacy of Neoadjuvant CROSS and TPF for Esophageal Squamous Cell Carcinoma - a Propensity Score Matched Analysis

Abstract

Esophageal Cancer: Oncology/Radiation Therapy Neoadjuvant therapy before resection has been shown to improve esophageal cancer-related survival and outcomes, but few studies have compared the outcomes from the two most widely used neoadjuvant protocols – the Taxotere, Platinol/Carbolatin, 5-fluorouracil (TPF/TJF) and the Chemoradiation for Esophageal Cancer followed by Surgery Study (CROSS) regimes. Our study was a retrospective, propensity score-matched cohort study. Patients with biopsy-confirmed esophageal squamous cell carcinoma who had received neoadjuvant TPF/TJF or CROSS, from January 2012 to January 2024, at a tertiary medical center in Hong Kong, were identified from a prospectively-maintained database. Patients who received treatment in a palliative intent, diagnosed with cervical esophageal carcinoma, received pharyngo-laryngo-esophagectomy, or had an unknown clinical TNM staging were excluded. Patients who received TPF/TJF were matched in a 1:1 ratio to patients who received CROSS using a propensity score controlling for age, sex, clinical TNM staging, presence of multiple sites of lymph node metastasis, tumor length and tumor location. The primary outcome was overall survival (OS) of patients in the two groups. The secondary outcomes were recurrence-free survival, post-neoadjuvant pathological staging and rates of pathological complete response. We identified 242 patients treated with neoadjuvant TPF or CROSS, and eventually included 54 in the TPF group and 51 matched patients in the CROSS group according to preset selection criteria. The median age of both groups was 64 years old. 74% of the TPF group versus 92% of the CROSS group eventually underwent surgical resection (p=0.019). For the primary outcome, median OS after date of first treatment in the TPF group was 18.7 months, compared with 72 months in the CROSS group (p=0.062). For the secondary outcomes, mean recurrence-free survival was similar in the two groups (69.0 months in CROSS group versus 101.2 months in TPF group, p=0.931). Overall post-neoadjuvant pathological staging was significantly higher in the TPF group, and post-neoadjuvant pathological complete response rate was also significantly lower in the TPF group (5% in TPF group versus 28% in CROSS group, p=0.005). Neoadjuvant CROSS led to a significantly longer median overall survival when compared to neoadjuvant TPF for patients in our cohort, likely due to a significantly better tumor response as evident by a lower post-neoadjuvant pathological staging and a higher pathological complete response rate in the CROSS group. Recurrence-free survival was similar between the two groups. Our data suggests that CROSS may be the superior neoadjuvant regime for patients with locally advanced esophageal squamous cell carcinoma.