• Styliani Mantziari, Caroline Gronnier, Florence Renaud, Alain Duhamel, Jérémie Théreaux, Cécile Brigand, Nicolas Carrère, Jérémie H Lefevre, Arnaud Pasquer, Nicolas Demartines, Denis Collet, Bernard Meunier, Christophe Mariette, and FREGAT working group – FRENCH – AFC.
• *Department of Visceral Surgery, Lausanne University Hospital, Lausanne, Switzerland †UniversityLille, Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, Lille, France ‡Department of Digestive Surgery, Haut-Lévêque University Hospital, Bordeaux, France §UniversityLille, Department of Pathology, University Hospital, Lille, France ¶UniversityLille, UMR-S 1172 - JPARC - Centre de Recherche Jean-Pierre AUBERT Neurosciences et Cancer, Lille, France ||Inserm, UMR-S 1172, Lille, France **UniversityLille, Department of Biostatistics, University Hospital, Lille, France ††SIRIC (Site de Recherche Intégrée en Cancérologie) OncoLille, France ‡‡Department of Digestive Surgery, Cavale Blanche University Hospital, Brest, France §§Department of General and Digestive Surgery, Hautepierre University Hospital, Strasbourg, France ¶¶Department of General and Digestive Surgery, Purpan University Hospital, Toulouse, France ||||Department of Digestive Surgery, Saint-Antoine University Hospital, Paris, France ***Department of Digestive Surgery, Edouard Herriot University Hospital, Lyon, France †††Department of Digestive and Hepatobiliary Surgery, Pontchaillou University Hospital, Rennes, France.
• Ann. Surg. 2017 Nov 1; 266 (5): 805-813.

BackgroundBased on current guidelines, clinical T3N0M0 esophageal tumors may or may not receive neoadjuvant treatment, according to their perception as locally advanced (cT3) or early-stage tumors (stage II). The study aim was to assess the impact of neoadjuvant treatment upon survival for cT3N0M0 esophageal cancer patients, with subgroup analyses by histological type (squamous cell carcinoma vs adenocarcinoma) and type of neoadjuvant treatment (chemotherapy vs radiochemotherapy).MethodsData from patients operated on for esophageal cancer in 30 European centers were collected. Among the 382 of 2944 patients with clinical T3N0M0 stage at initial diagnosis (13.0%), we compared those treated with primary surgery (S, n = 193) versus with neoadjuvant treatment plus surgery (NS, n = 189).ResultsThe S and NS groups were similar regarding their demographic and surgical characteristics. In-hospital postoperative morbidity and mortality rates were comparable between groups. Patients were found to be pN+ in 64.2% versus 42.9% in the S and NS groups respectively (P < 0.001), pN2/N3 in 35.2% versus 21.2% (P < 0.001), stage 0 in 0% versus 16.4% (P < 0.001), and R0 in 81.3% versus 89.4% of cases (P = 0.026). Median overall and disease-free survivals were significantly better in the NS group, 38.4 versus 27.9 months (P = 0.007) and 31.6 versus 27.5 months (P = 0.040), respectively, and this difference remained for both histological types. Radiotherapy did not offer a benefit compared with chemotherapy alone (P = 0.687). In multivariable analysis, neoadjuvant treatment was an independent favorable prognostic factor (HR 0.76, 95% CI 0.58-0.99, P = 0.044).ConclusionNeoadjuvant treatment offers a significant survival benefit for clinical T3N0M0 esophageal cancer.

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