Chemoradiotherapy Followed by Active Surveillance Versus Standard Esophagectomy for Esophageal Cancer: A Systematic Review and Individual Patient Data Meta-analysis

Berend J van der Wilk; Ben M Eyck; Wayne L Hofstetter; Jaffer A Ajani; Guillaume Piessen; Carlo Castoro; Rita Alfieri; Jong H Kim; Sung-Bae Kim; Heidi Furlong; Thomas N Walsh; Daan Nieboer; Bas P L Wijnhoven; Sjoerd M Lagarde; J Jan B van Lanschot

doi:10.1097/SLA.0000000000004930

Chemoradiotherapy Followed by Active Surveillance Versus Standard Esophagectomy for Esophageal Cancer: A Systematic Review and Individual Patient Data Meta-analysis

Berend J van der Wilk, Ben M Eyck, Wayne L Hofstetter, Jaffer A Ajani, Guillaume Piessen, Carlo Castoro, Rita Alfieri, Jong H Kim, Sung-Bae Kim, Heidi Furlong, Thomas N Walsh, Daan Nieboer, Bas P L Wijnhoven, Sjoerd M Lagarde, J Jan B van Lanschot

Research output: Contribution to journal › Article › Academic › peer-review

4 Citations (Scopus)

Abstract

OBJECTIVE: To compare overall survival of patients with a cCR undergoing active surveillance versus standard esophagectomy.

SUMMARY OF BACKGROUND DATA: One-third of patients with esophageal cancer have a pathologically complete response in the resection specimen after neoadjuvant chemoradiotherapy. Active surveillance may be of benefit in patients with cCR, determined with diagnostics during response evaluations after chemoradiotherapy.

METHODS: A systematic review and meta-analysis was performed comparing overall survival between patients with cCR after chemoradiotherapy undergoing active surveillance versus standard esophagectomy. Authors were contacted to supply individual patient data. Overall and progression-free survival were compared using random effects meta-analysis of randomized or propensity score matched data. Locoregional recurrence rate was assessed. The study-protocol was registered (PROSPERO: CRD42020167070).

RESULTS: Seven studies were identified comprising 788 patients, of which after randomization or propensity score matching yielded 196 active surveillance and 257 standard esophagectomy patients. All authors provided individual patient data. The risk of all-cause mortality for active surveillance was 1.08 [95% confidence interval (CI): 0.62-1.87, P = 0.75] after intention-to-treat analysis and 0.93 (95% CI: 0.56-1.54, P = 0.75) after per-protocol analysis. The risk of progression or all-cause mortality for active surveillance was 1.14 (95% CI: 0.83-1.58, P = 0.36). Five-year locoregional recurrence rate during active surveillance was 40% (95% CI: 26%-59%). 95% of active surveillance patients undergoing postponed esophagectomy for locoregional recurrence had radical resection.

CONCLUSIONS: Overall survival was comparable in patients with cCR after chemoradiotherapy undergoing active surveillance or standard esophagectomy. Diagnostic follow-up is mandatory in active surveillance and postponed esophagectomy should be offered to operable patients in case of locoregional recurrence.

Original language	English
Pages (from-to)	467-476
Number of pages	10
Journal	Annals of Surgery
Volume	275
Issue number	3
DOIs	https://doi.org/10.1097/SLA.0000000000004930
Publication status	Published - Mar 2022

Bibliographical note

Funding Information: This study was funded by the Dutch Cancer Society and Netherlands Organization for Health Research and Development.

Publisher Copyright: © 2022 Lippincott Williams and Wilkins. All rights reserved.

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This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1097/SLA.0000000000004930

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van der Wilk, B. J., Eyck, B. M., Hofstetter, W. L., Ajani, J. A., Piessen, G., Castoro, C., Alfieri, R., Kim, J. H., Kim, S-B., Furlong, H., Walsh, T. N., Nieboer, D., Wijnhoven, B. P. L., Lagarde, S. M., & Lanschot, J. J. B. V. (2022). Chemoradiotherapy Followed by Active Surveillance Versus Standard Esophagectomy for Esophageal Cancer: A Systematic Review and Individual Patient Data Meta-analysis. Annals of Surgery, 275(3), 467-476. https://doi.org/10.1097/SLA.0000000000004930

@article{129201df80e946749b8ec29b05d05d92,

title = "Chemoradiotherapy Followed by Active Surveillance Versus Standard Esophagectomy for Esophageal Cancer: A Systematic Review and Individual Patient Data Meta-analysis",

abstract = "OBJECTIVE: To compare overall survival of patients with a cCR undergoing active surveillance versus standard esophagectomy.SUMMARY OF BACKGROUND DATA: One-third of patients with esophageal cancer have a pathologically complete response in the resection specimen after neoadjuvant chemoradiotherapy. Active surveillance may be of benefit in patients with cCR, determined with diagnostics during response evaluations after chemoradiotherapy.METHODS: A systematic review and meta-analysis was performed comparing overall survival between patients with cCR after chemoradiotherapy undergoing active surveillance versus standard esophagectomy. Authors were contacted to supply individual patient data. Overall and progression-free survival were compared using random effects meta-analysis of randomized or propensity score matched data. Locoregional recurrence rate was assessed. The study-protocol was registered (PROSPERO: CRD42020167070).RESULTS: Seven studies were identified comprising 788 patients, of which after randomization or propensity score matching yielded 196 active surveillance and 257 standard esophagectomy patients. All authors provided individual patient data. The risk of all-cause mortality for active surveillance was 1.08 [95% confidence interval (CI): 0.62-1.87, P = 0.75] after intention-to-treat analysis and 0.93 (95% CI: 0.56-1.54, P = 0.75) after per-protocol analysis. The risk of progression or all-cause mortality for active surveillance was 1.14 (95% CI: 0.83-1.58, P = 0.36). Five-year locoregional recurrence rate during active surveillance was 40% (95% CI: 26%-59%). 95% of active surveillance patients undergoing postponed esophagectomy for locoregional recurrence had radical resection.CONCLUSIONS: Overall survival was comparable in patients with cCR after chemoradiotherapy undergoing active surveillance or standard esophagectomy. Diagnostic follow-up is mandatory in active surveillance and postponed esophagectomy should be offered to operable patients in case of locoregional recurrence.",

author = "{van der Wilk}, {Berend J} and Eyck, {Ben M} and Hofstetter, {Wayne L} and Ajani, {Jaffer A} and Guillaume Piessen and Carlo Castoro and Rita Alfieri and Kim, {Jong H} and Sung-Bae Kim and Heidi Furlong and Walsh, {Thomas N} and Daan Nieboer and Wijnhoven, {Bas P L} and Lagarde, {Sjoerd M} and Lanschot, {J Jan B van}",

note = "Funding Information: This study was funded by the Dutch Cancer Society and Netherlands Organization for Health Research and Development. Publisher Copyright: {\textcopyright} 2022 Lippincott Williams and Wilkins. All rights reserved.",

year = "2022",

month = mar,

doi = "10.1097/SLA.0000000000004930",

language = "English",

volume = "275",

pages = "467--476",

journal = "Annals of Surgery",

issn = "0003-4932",

publisher = "Lippincott Williams & Wilkins",

number = "3",

}

van der Wilk, BJ , Eyck, BM, Hofstetter, WL, Ajani, JA, Piessen, G, Castoro, C, Alfieri, R, Kim, JH, Kim, S-B, Furlong, H, Walsh, TN, Nieboer, D , Wijnhoven, BPL , Lagarde, SM & Lanschot, JJBV 2022, 'Chemoradiotherapy Followed by Active Surveillance Versus Standard Esophagectomy for Esophageal Cancer: A Systematic Review and Individual Patient Data Meta-analysis', Annals of Surgery, vol. 275, no. 3, pp. 467-476. https://doi.org/10.1097/SLA.0000000000004930

Chemoradiotherapy Followed by Active Surveillance Versus Standard Esophagectomy for Esophageal Cancer: A Systematic Review and Individual Patient Data Meta-analysis. / van der Wilk, Berend J ; Eyck, Ben M; Hofstetter, Wayne L et al.
In: Annals of Surgery, Vol. 275, No. 3, 03.2022, p. 467-476.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Chemoradiotherapy Followed by Active Surveillance Versus Standard Esophagectomy for Esophageal Cancer

T2 - A Systematic Review and Individual Patient Data Meta-analysis

AU - van der Wilk, Berend J

AU - Eyck, Ben M

AU - Hofstetter, Wayne L

AU - Ajani, Jaffer A

AU - Piessen, Guillaume

AU - Castoro, Carlo

AU - Alfieri, Rita

AU - Kim, Jong H

AU - Kim, Sung-Bae

AU - Furlong, Heidi

AU - Walsh, Thomas N

AU - Nieboer, Daan

AU - Wijnhoven, Bas P L

AU - Lagarde, Sjoerd M

AU - Lanschot, J Jan B van

N1 - Funding Information: This study was funded by the Dutch Cancer Society and Netherlands Organization for Health Research and Development. Publisher Copyright: © 2022 Lippincott Williams and Wilkins. All rights reserved.

PY - 2022/3

Y1 - 2022/3

N2 - OBJECTIVE: To compare overall survival of patients with a cCR undergoing active surveillance versus standard esophagectomy.SUMMARY OF BACKGROUND DATA: One-third of patients with esophageal cancer have a pathologically complete response in the resection specimen after neoadjuvant chemoradiotherapy. Active surveillance may be of benefit in patients with cCR, determined with diagnostics during response evaluations after chemoradiotherapy.METHODS: A systematic review and meta-analysis was performed comparing overall survival between patients with cCR after chemoradiotherapy undergoing active surveillance versus standard esophagectomy. Authors were contacted to supply individual patient data. Overall and progression-free survival were compared using random effects meta-analysis of randomized or propensity score matched data. Locoregional recurrence rate was assessed. The study-protocol was registered (PROSPERO: CRD42020167070).RESULTS: Seven studies were identified comprising 788 patients, of which after randomization or propensity score matching yielded 196 active surveillance and 257 standard esophagectomy patients. All authors provided individual patient data. The risk of all-cause mortality for active surveillance was 1.08 [95% confidence interval (CI): 0.62-1.87, P = 0.75] after intention-to-treat analysis and 0.93 (95% CI: 0.56-1.54, P = 0.75) after per-protocol analysis. The risk of progression or all-cause mortality for active surveillance was 1.14 (95% CI: 0.83-1.58, P = 0.36). Five-year locoregional recurrence rate during active surveillance was 40% (95% CI: 26%-59%). 95% of active surveillance patients undergoing postponed esophagectomy for locoregional recurrence had radical resection.CONCLUSIONS: Overall survival was comparable in patients with cCR after chemoradiotherapy undergoing active surveillance or standard esophagectomy. Diagnostic follow-up is mandatory in active surveillance and postponed esophagectomy should be offered to operable patients in case of locoregional recurrence.

AB - OBJECTIVE: To compare overall survival of patients with a cCR undergoing active surveillance versus standard esophagectomy.SUMMARY OF BACKGROUND DATA: One-third of patients with esophageal cancer have a pathologically complete response in the resection specimen after neoadjuvant chemoradiotherapy. Active surveillance may be of benefit in patients with cCR, determined with diagnostics during response evaluations after chemoradiotherapy.METHODS: A systematic review and meta-analysis was performed comparing overall survival between patients with cCR after chemoradiotherapy undergoing active surveillance versus standard esophagectomy. Authors were contacted to supply individual patient data. Overall and progression-free survival were compared using random effects meta-analysis of randomized or propensity score matched data. Locoregional recurrence rate was assessed. The study-protocol was registered (PROSPERO: CRD42020167070).RESULTS: Seven studies were identified comprising 788 patients, of which after randomization or propensity score matching yielded 196 active surveillance and 257 standard esophagectomy patients. All authors provided individual patient data. The risk of all-cause mortality for active surveillance was 1.08 [95% confidence interval (CI): 0.62-1.87, P = 0.75] after intention-to-treat analysis and 0.93 (95% CI: 0.56-1.54, P = 0.75) after per-protocol analysis. The risk of progression or all-cause mortality for active surveillance was 1.14 (95% CI: 0.83-1.58, P = 0.36). Five-year locoregional recurrence rate during active surveillance was 40% (95% CI: 26%-59%). 95% of active surveillance patients undergoing postponed esophagectomy for locoregional recurrence had radical resection.CONCLUSIONS: Overall survival was comparable in patients with cCR after chemoradiotherapy undergoing active surveillance or standard esophagectomy. Diagnostic follow-up is mandatory in active surveillance and postponed esophagectomy should be offered to operable patients in case of locoregional recurrence.

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U2 - 10.1097/SLA.0000000000004930

DO - 10.1097/SLA.0000000000004930

M3 - Article

C2 - 34191461

AN - SCOPUS:85123079396

SN - 0003-4932

VL - 275

SP - 467

EP - 476

JO - Annals of Surgery

JF - Annals of Surgery

IS - 3

ER -

Chemoradiotherapy Followed by Active Surveillance Versus Standard Esophagectomy for Esophageal Cancer: A Systematic Review and Individual Patient Data Meta-analysis

Abstract

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