Abstract Background Neoadjuvant therapy (NAT) in locally advanced oesophageal cancer is proven to have better survival benefit than upfront surgery. A recent Randomised Controlled Study suggests that FLOT regime therapy provides better disease-free survival than traditional CROSS neoadjuvant therapy. However, this did not translate equally in other retrospective studies. As it stands, not enough evidence exists as of yet to compare overall and 5-year survival between FLOT and chemoradiation therapy for oesophageal and junctional cancer. Methods 156 patients included in a retrospective analysis of comprehensive prospectively collected cancer Database between 2012–2024 in a high-volume centralized quaternary center was performed with primary objective of establishing 5-years and overall survival difference between FLOT and chemoradiotherapy (CROSS, Cis/5FU) in patients with Oesophageal and Oesophagogastric junction Tumours who underwent curative intent resection. Secondary objectives looked at differences in tumor regression grade (TRG), complete pathological response, complications, length of stay, margin status, nodal count and ypTN status between the two neoadjuvant regimens. Independent statistical analysis taken place utilizing SAS v9.4. CI set at 95%, p value ≤0.05 is considered statistically significant. Results There was no significant association between overall survival and type of NAT (p = 0.6485) nor between death at 1-year (p = 0.7897) or 2-years (p = 0.7204). However, adjusted for TRG, preop N stage, Margin and ypTN Staging, an association was found at 5-years (p = 0.0064), with chemoradiotherapy patients having 10.6 times higher odds of dying than those with FLOT (Odds Ratio = 10.61, 95% CI: 1.94, 58.03). Additionally, chemoradiotherapy had 71% lower odds of high Tumour Regression Grade than FLOT (p = 0.0209, Odds Ratio = 0.29, 95% CI: 0.10, 0.83). Lower R1 rates and lymph node counts in the chemoradiotherapy group were found but did not amount to statistical significance. Conclusion Our study is the first real-world evidence supporting a recently published improved survival in the FLOT arm when compared to chemoradiotherapy, after adjusting for confounders. Furthermore, FLOT neoadjuvant therapy had better TRG than the chemoradiotherapy arm. Larger cooperative research, including survival analysis for patients receiving adjuvant therapy following preoperative chemoradiotherapy is needed.
Alhayo et al. (Fri,) studied this question.