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Background <p>Neoadjuvant chemotherapy (nCT) for esophageal and esophagogastric junction (EGJ) adenocarcinoma is associated with better survival but worse pathological complete response (pCR) rate as compared with 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.</p> Patients and Methods <p>A systematic review of the literature in PubMed, Embase and web sources was performed up to November 2025. Studies comparing nCT and nCRT in patients with esophageal or EGJ adenocarcinoma and pCR were identified. An individual patient-data (IPD) meta-analysis was performed for overall survival (OS) and disease-free survival (DFS).</p> Results <p>Overall, 1454 patients from six different studies were included (374 in nCT group and 1080 in nCRT group). 1-, 3-, and 5-year OS was superior in the nCT group as compared with nCRT group, being 95.4% versus 87.8%, 81.5% versus 64.8% and 73.8% versus 56%, respectively (<i>p</i> &lt; 0.001). Analogously, superior DFS was observed for the nCT group at one, three and 5 years (<i>p</i> &lt; 0.001). In the one-stage meta-analysis nCT was associated with decreased risk of death (HR = 0.49, <i>p</i> &lt; 0.001) and recurrence (HR = 0.24, <i>p</i> &lt;0.001).</p> Conclusions <p>The present study showed better long-term outcomes in patients with pCR after nCT when compared with nCRT, highlighting the better systemic disease control offered by the first. This consideration suggests that pCR cannot be considered as a prognostic surrogate per se but the integration of this concept with the type of preoperative strategy is crucial.</p>

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Beyond Pathological Complete Response: Long-term Outcomes in Esophageal and Esophagogastric Junction Adenocarcinoma After Multimodal Therapy—A Systematic Review and Individual Patient-Data Meta-Analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月27日

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  • Luca Risi,
  • Renato De Martino,
  • Lorenzo Giorgi,
  • Paolo Enrico Meneghesso,
  • Andrea Pansa,
  • Silvia Basato,
  • Carlo Castoro,
  • Rita Alfieri,
  • Giovanni Maria Garbarino

摘要

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 with 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.

Patients and Methods

A systematic review of the literature in PubMed, Embase and web sources was performed up to November 2025. Studies comparing nCT and nCRT in patients with esophageal or EGJ adenocarcinoma and pCR were identified. An individual patient-data (IPD) meta-analysis was performed for overall survival (OS) and disease-free survival (DFS).

Results

Overall, 1454 patients from six different studies were included (374 in nCT group and 1080 in nCRT group). 1-, 3-, and 5-year OS was superior in the nCT group as compared with nCRT group, being 95.4% versus 87.8%, 81.5% versus 64.8% and 73.8% versus 56%, respectively (p < 0.001). Analogously, superior DFS was observed for the nCT group at one, three and 5 years (p < 0.001). In the one-stage meta-analysis nCT was associated with decreased risk of death (HR = 0.49, p < 0.001) and recurrence (HR = 0.24, p <0.001).

Conclusions

The present study showed better long-term outcomes in patients with pCR after nCT when compared with nCRT, highlighting the better systemic disease control offered by the first. This consideration suggests that pCR cannot be considered as a prognostic surrogate per se but the integration of this concept with the type of preoperative strategy is crucial.