Perioperative Treatment, Not Surgical Approach, Influences Overall Survival in Patients with Gastroesophageal Junction Tumors: A Nationwide, Population-Based Study in The Netherlands

Abstract

BACKGROUND: Resectable gastroesophageal junction (GEJ) tumors are treated either with an esophageal-cardia resection or with gastrectomy. The difference in outcome between these two treatment modalities is unknown; Therefore, the aim of this study was to evaluate population-based treatment strategies for patients with resectable adenocarcinomas of the GEJ and to compare the oncological outcomes. METHODS: Patients with potentially resectable GEJ tumors diagnosed between 2005 and 2012 were selected from the nationwide, population-based Netherlands Cancer Registry. Differences between patients were compared using the χ (2) test, and survival curves were generated using the Kaplan-Meier method. Overall multivariate survival was assessed using Cox regression analyses. RESULTS: Patients treated with esophagectomy (n = 939) were significantly younger than patients treated with gastrectomy (n = 257; 64 vs. 66 years; p < 0.001), and no differences were noted regarding lymph node yield, lymph node ratio, and radicality. Patients treated with an esophagectomy or gastrectomy exhibited comparable overall 5-year survival rates (36 vs. 33 %, respectively; p = 0.250). Multivariate analysis showed that patients receiving perioperative treatment and gastrectomy exhibited similar overall survival rates compared with patients receiving perioperative treatment and esophagectomy [hazard ratio (HR) 1.9, 95 % confidence interval (CI) 0.7-1.3; p = 0.908]; however, patients receiving esophagectomy alone (HR 1.3, 95 % CI 1.3-1.8; p = 0.002) or gastrectomy alone (HR 1.8, 95 % CI 1.4-2.4; p < 0.001) exhibited a significantly worse overall survival. CONCLUSIONS: The chosen type of surgery (esophagectomy or gastrectomy) did not influence the overall survival in our cohort of patients with GEJ tumors. The administration of perioperative chemo(radio)therapy improved survival regardless of the surgical approach.