进行了一项多国大容量中心研究，以评估 cT2 期食管 (EAC) 和胃食管交界处 (GEJ) 腺癌初次手术 (PS) 或新辅助治疗随后手术 (NAT/S) 后的结果。最佳治疗由于缺乏随机对照试验，针对临床分期 cT2cNany 或 cT2N0 EAC 和 GEJ 的 NAT/S 或 PS 方法仍然未知。对来自 10 个中心的前瞻性维护数据库进行了回顾性分析。 2012 年 1 月至 2023 年 8 月期间，645 名符合 GEJ Siewert I 型、II 型或 EAC 纳入标准且诊断时具有 cT2 状态的患者接受了 PS 或 NAT/S 治疗。主要终点是总生存期 (OS)。在 cT2cNany 队列中，192 名患者 (29.8%) 接受了 PS，453 名患者 (70.2%) 接受了 NAT/S。在所有 cT2cN0 患者 (n=333) 中，NAT/s 仍然是更频繁的治疗 (56.2%)。两个 cT2 队列中接受 PS 的患者年龄均较大 (P<0.001)，且 ASA 分类较高 (P<0.05)。 R0 切除显示两个 cT2 队列中 NAT/S 和 PS 之间没有差异 (P>0.4)。PS 组的中位 OS 为 51.0 个月 (95% CI 31.6-70.4)，而对照组的中位 OS 为 114.0 个月 (95% CI 53.9-174.1)。 cT2cNany 患者的 NAT/S 组（P=0.003）。对于 cT2cN0 患者，NAT/S 与更长的 OS (P=0.002) 和无病生存 (DFS) (P=0.001) 相关。对 cT2N0 患者进行倾向评分匹配后，NAT/S 的生存获益仍然存在（P=0.004）。组织病理学显示，38.1% 的 cT2cNany 和 34.2% 的 cT2cN0 患者未分期。由于 cT2N0 疾病的鉴定不可靠，应为所有患者提供多模式治疗方法。版权所有 © 2024 Wolters Kluwer Health, Inc. 保留所有权利。

A multi-national high-volume center study was undertaken to evaluate outcomes after primary surgery (PS) or neoadjuvant treatment followed by surgery (NAT/S) in cT2 staged adenocarcinomas of the esophagus (EAC) and gastroesophageal junction (GEJ).Optimal treatment approach with either NAT/S or PS for clinically staged cT2cNany or cT2N0 EAC and GEJ remains unknown due to the lack of randomized controlled trials.Retrospective analysis of prospectively maintained databases from ten centers was performed. Between 01/2012-08/2023 645 patients who fulfilled inclusion criteria of GEJ Siewert type I, II or EAC with cT2 status at diagnosis underwent PS or NAT/S with curative intent. Primary endpoint was overall survival (OS).In the cT2cNany cohort 192 patients (29.8%) underwent PS and 453 (70.2%) underwent NAT/S. In all cT2cN0 patients (n=333), NAT/s remained the more frequent treatment (56.2%). Patients undergoing PS were in both cT2 cohorts older (P<0.001) and had a higher ASA classification (P<0.05). R0 resection showed no differences between NAT/S and PS in both cT2 cohorts (P>0.4).Median OS was 51.0 months in the PS group (95% CI 31.6-70.4) versus 114.0 months (95% CI 53.9-174.1) in the NAT/S group (P=0.003) of cT2cNany patients. For cT2cN0 patients NAT/S was associated with longer OS (P=0.002) and disease-free survival (DFS) (P=0.001). After propensity score matching of cT2N0 patients, survival benefit for NAT/S remained (P=0.004). Histopathology showed that 38.1% of cT2cNany and 34.2% of cT2cN0 patients were understaged.Due to unreliable identification of cT2N0 disease, all patients should be offered a multimodal therapeutic approach.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.