Impact of postoperative chemotherapy in patients resected for esophagogastric adenocarcinoma with major pathological response after preoperative chemotherapy: a study from the FREGAT database

Background: In locally advanced esophagogastric adenocarcinoma (EGA), perioperative chemotherapy is the standard of care and can result in complete/major pathological response. In this setting, real-world data on the impact of postoperative chemotherapy are scarce. Objective: The primary objective was to assess the impact of postoperative chemotherapy on overall survival (OS) in cases of complete/major pathological response and/or no serosal involvement. Secondary endpoints were disease-free survival (DFS) and the identification of predictive factors associated with OS. Design: A retrospective comparative multicentric study was conducted using the nationwide, prospectively collected FREGAT (FRench EsoGAstric Tumor) database. Methods: Patients with EGA treated with perioperative chemotherapy registered in the FREGAT database who had a complete/major pathological response and/or no serosal involvement (ypT0–2 or ypT3 Mandard TRG 2, ypN0, R0) were included. Results: Among 1870 patients with EGA treated with perioperative chemotherapy identified in the FREGAT database, 345 met the inclusion criteria, and 218 (63.2%) received postoperative chemotherapy. Postoperative chemotherapy was associated with OS improvement regardless of the regimen used (median OS: not achieved vs 65.7 months; p < 0.0001). Similarly, DFS was improved with postoperative chemotherapy (median DFS: not achieved vs 65.7 months; p < 0.0001). In multivariable analysis, age, primary tumor location, postoperative complications, and no postoperative chemotherapy were associated with poorer survival outcomes. Conclusion: Postoperative chemotherapy after resection of EGA with complete/major pathological response and/or tumors without serosal involvement remains the standard of care, improves survival outcomes, and should be recommended when the patient’s condition allows it.