Abstract Background Neoadjuvant chemotherapy (nCT) for esophageal and esophagogastric junction (EGJ) adenocarcinoma is associated with better survival but worse pathological complete response (pCR) rate as compared to neoadjuvant chemoradiotherapy (nCRT). The aim of the present study is to compare long-term outcomes in patients with esophageal or EGJ adenocarcinoma and pCR after nCT or nCRT. Methods A systematic review of the literature in PubMed, Embase and web sources was performed up to 2 February 2025. Studies comparing nCT and nCRT in patients with esophageal or EGJ adenocarcinoma and pCR were identified. The outcomes considered were: overall survival (OS), disease free survival (DFS) and site of recurrence. Results Overall, 1015 patients from four studies were included (235 in nCT group and 780 in nCRT group). Overall, 1-, 3- and 5-year OS were superior in nCT group as compared to nCRT group for almost all studies. Three-year OS was 84–91% for nCT group and 57.2–86% for nCRT group while five-year OS was 69–87% and 51–79%, respectively. Analogously, DFS was superior in nCT group at one, three and five years in all studies. As regards the pattern of recurrence, a better control of the distant recurrence after nCT was shown while nCRT offered a better control of the local disease. Conclusion There is an urge to reconsider the validity of pCR as an oncological surrogate and its impact on postoperative decisions depending on the preoperative approach. In the present circumstances, the pattern of recurrence may represent the key answer.
Risi et al. (Fri,) studied this question.