{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,2]],"date-time":"2025-11-02T16:45:20Z","timestamp":1762101920966},"reference-count":39,"publisher":"Oxford University Press (OUP)","issue":"13","license":[{"start":{"date-parts":[[2016,9,30]],"date-time":"2016-09-30T00:00:00Z","timestamp":1475193600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2016,11,30]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Randomized trials have shown that neoadjuvant treatment improves survival in the curative treatment of oesophageal and gastro-oesophageal junction cancer. Results from population-based observational studies are, however, sparse and ambiguous.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This prospective population-based cohort study included all patients who had oesophagectomy for cancer in Sweden, excluding clinical T1 N0, recorded in the National Register for Oesophageal and Gastric Cancer, 2006\u20132014. Patients were stratified into three groups: surgery alone, neoadjuvant chemotherapy and neoadjuvant chemoradiotherapy.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Neoadjuvant treatment was given to 521 patients (51\u00b71 per cent) and 499 (48\u00b79 per cent) received surgery alone. Neoadjuvant chemotherapy increased the risk of postoperative surgical complications compared with surgery alone (adjusted odds ratio 2\u00b701, 95 per cent c.i. 1\u00b724 to 3\u00b725; P = 0\u00b7005). Postoperative mortality was significantly increased after neoadjuvant chemoradiotherapy compared with surgery alone (odds ratio 2\u00b737, 1\u00b706 to 5\u00b729; P = 0\u00b7035). Survival improved in patients with squamous cell carcinoma after neoadjuvant chemotherapy, whereas after neoadjuvant chemoradiotherapy survival was significantly improved only in the subgroup with the highest performance status and without known co-morbidity. In adenocarcinoma there was a trend towards improved overall survival after neoadjuvant chemotherapy, but neoadjuvant chemoradiotherapy did not offer a survival benefit. Stratified analysis including only patients with adenocarcinoma in the highest performance category without known co-morbidity showed a strong trend towards improved survival after neoadjuvant chemotherapy compared with surgery alone (adjusted hazard ratio 0\u00b747, 0\u00b721 to 1\u00b704; P = 0\u00b7061).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>For patients with squamous cell carcinoma of the oesophagus or gastro-oesophageal junction, neoadjuvant treatments seemed to increase long-term survival, but also the risk of postoperative morbidity and mortality, compared with surgery alone. Neither neoadjuvant treatment option seemed to improve survival significantly among patients with adenocarcinoma, compared with surgery alone.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1002\/bjs.10304","type":"journal-article","created":{"date-parts":[[2016,10,4]],"date-time":"2016-10-04T15:14:46Z","timestamp":1475594086000},"page":"1864-1873","source":"Crossref","is-referenced-by-count":26,"title":["Outcome of neoadjuvant therapies for cancer of the oesophagus or gastro-oesophageal junction based on a national data registry"],"prefix":"10.1093","volume":"103","author":[{"given":"F","family":"Klevebro","sequence":"first","affiliation":[{"name":"Division of Surgery, Department of Clinical Science Intervention and Technology, Karolinska Institute, and Centre for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M","family":"Lindblad","sequence":"additional","affiliation":[{"name":"Division of Surgery, Department of Clinical Science Intervention and Technology, Karolinska Institute, and Centre for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J","family":"Johansson","sequence":"additional","affiliation":[{"name":"Department of Surgery, Sk\u00e5ne University Hospital, Lund University, Lund, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"L","family":"Lundell","sequence":"additional","affiliation":[{"name":"Division of Surgery, Department of Clinical Science Intervention and Technology, Karolinska Institute, and Centre for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M","family":"Nilsson","sequence":"additional","affiliation":[{"name":"Division of Surgery, Department of Clinical Science Intervention and Technology, Karolinska Institute, and Centre for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2016,9,30]]},"reference":[{"key":"2021022314085024300_bjs10304-bib-0001","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1308\/003588414X14055925061630","article-title":"Systematic review of enhanced recovery after gastro-oesophageal cancer surgery","volume":"97","author":"Gemmill","year":"2015","journal-title":"Ann R Coll Surg Engl"},{"key":"2021022314085024300_bjs10304-bib-0002","doi-asserted-by":"crossref","first-page":"1393","DOI":"10.1136\/gutjnl-2013-306074","article-title":"Hospital and surgeon volume in relation to long-term survival after oesophagectomy: systematic review and meta-analysis","volume":"63","author":"Brusselaers","year":"2014","journal-title":"Gut"},{"key":"2021022314085024300_bjs10304-bib-0003","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1056\/NEJMoa055531","article-title":"MAGIC Trial Participants. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer","volume":"355","author":"Cunningham","year":"2006","journal-title":"N Engl J Med"},{"key":"2021022314085024300_bjs10304-bib-0004","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1016\/S1470-2045(07)70039-6","article-title":"Survival benefits from neoadjuvant chemoradiotherapy or chemotherapy in oesophageal carcinoma: a meta-analysis","volume":"8","author":"Gebski","year":"2007","journal-title":"Lancet Oncol"},{"key":"2021022314085024300_bjs10304-bib-0005","doi-asserted-by":"crossref","first-page":"1727","DOI":"10.1016\/S0140-6736(02)08651-8","article-title":"Surgical resection with or without preoperative chemotherapy in oesophageal cancer: a randomised controlled trial","volume":"359","author":"Medical Research Council Oesophageal Cancer Working Group","year":"2002","journal-title":"Lancet"},{"key":"2021022314085024300_bjs10304-bib-0006","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1016\/S1470-2045(11)70142-5","article-title":"Australasian Gastro-Intestinal Trials Group. Survival after neoadjuvant chemotherapy or chemoradiotherapy for resectable oesophageal carcinoma: an updated meta-analysis","volume":"12","author":"Sjoquist","year":"2011","journal-title":"Lancet Oncol"},{"key":"2021022314085024300_bjs10304-bib-0007","doi-asserted-by":"crossref","first-page":"538","DOI":"10.1016\/S0002-9610(03)00066-7","article-title":"A meta-analysis of randomized controlled trials that compared neoadjuvant chemoradiation and surgery to surgery alone for resectable esophageal cancer","volume":"185","author":"Urschel","year":"2003","journal-title":"Am J Surg"},{"key":"2021022314085024300_bjs10304-bib-0008","doi-asserted-by":"crossref","first-page":"1715","DOI":"10.1200\/JCO.2010.33.0597","article-title":"Perioperative chemotherapy compared with surgery alone for resectable gastroesophageal adenocarcinoma: an FNCLCC and FFCD multicenter phase III trial","volume":"29","author":"Ychou","year":"2011","journal-title":"J Clin Oncol"},{"key":"2021022314085024300_bjs10304-bib-0009","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1002\/bjs.9418","article-title":"Meta-analysis of postoperative morbidity and perioperative mortality in patients receiving neoadjuvant chemotherapy or chemoradiotherapy for resectable oesophageal and gastro-oesophageal junctional cancers","volume":"101","author":"Kumagai","year":"2014","journal-title":"Br J Surg"},{"key":"2021022314085024300_bjs10304-bib-0010","doi-asserted-by":"crossref","first-page":"2165","DOI":"10.1002\/1097-0142(20010601)91:11<2165::AID-CNCR1245>3.0.CO;2-H","article-title":"Only pathologic complete response to neoadjuvant chemotherapy improves significantly the long term survival of patients with resectable esophageal squamous cell carcinoma: final report of a randomized, controlled trial of preoperative chemotherapy versus surgery alone","volume":"91","author":"Ancona","year":"2001","journal-title":"Cancer"},{"key":"2021022314085024300_bjs10304-bib-0011","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1186\/1471-2407-11-181","article-title":"Chemotherapy followed by surgery versus surgery alone in patients with resectable oesophageal squamous cell carcinoma: long-term results of a randomized controlled trial","volume":"11","author":"Boonstra","year":"2011","journal-title":"BMC Cancer"},{"key":"2021022314085024300_bjs10304-bib-0012","doi-asserted-by":"crossref","first-page":"1979","DOI":"10.1056\/NEJM199812313392704","article-title":"Chemotherapy followed by surgery compared with surgery alone for localized esophageal cancer","volume":"339","author":"Kelsen","year":"1998","journal-title":"N Engl J Med"},{"key":"2021022314085024300_bjs10304-bib-0013","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1056\/NEJM199707173370304","article-title":"Chemoradiotherapy followed by surgery compared with surgery alone in squamous-cell cancer of the esophagus","volume":"337","author":"Bosset","year":"1997","journal-title":"N Engl J Med"},{"key":"2021022314085024300_bjs10304-bib-0014","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1016\/S1470-2045(05)70288-6","article-title":"Trans-Tasman Radiation Oncology Group, Australasian Gastro-Intestinal Trials Group. Surgery alone versus chemoradiotherapy followed by surgery for resectable cancer of the oesophagus: a randomised controlled phase III trial","volume":"6","author":"Burmeister","year":"2005","journal-title":"Lancet Oncol"},{"key":"2021022314085024300_bjs10304-bib-0015","doi-asserted-by":"crossref","first-page":"2416","DOI":"10.1200\/JCO.2013.53.6532","article-title":"Surgery alone versus chemoradiotherapy followed by surgery for stage I and II esophageal cancer: final analysis of randomized controlled phase III trial FFCD 9901","volume":"32","author":"Mariette","year":"2014","journal-title":"J Clin Oncol"},{"key":"2021022314085024300_bjs10304-bib-0016","doi-asserted-by":"crossref","first-page":"2074","DOI":"10.1056\/NEJMoa1112088","article-title":"CROSS Group. Preoperative chemoradiotherapy for esophageal or junctional cancer","volume":"366","author":"van Hagen","year":"2012","journal-title":"N Engl J Med"},{"key":"2021022314085024300_bjs10304-bib-0017","doi-asserted-by":"crossref","first-page":"920","DOI":"10.1016\/j.ejso.2015.03.226","article-title":"Morbidity and mortality after surgery for cancer of the oesophagus and gastro-oesophageal junction: a randomized clinical trial of neoadjuvant chemotherapy vs. neoadjuvant chemoradiation","volume":"41","author":"Klevebro","year":"2015","journal-title":"Eur J Surg Oncol"},{"key":"2021022314085024300_bjs10304-bib-0018","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1016\/j.ejca.2010.09.009","article-title":"Is concurrent radiation therapy required in patients receiving preoperative chemotherapy for adenocarcinoma of the oesophagus? A randomised phase II trial","volume":"47","author":"Burmeister","year":"2011","journal-title":"Eur J Cancer"},{"key":"2021022314085024300_bjs10304-bib-0019","doi-asserted-by":"crossref","first-page":"660","DOI":"10.1093\/annonc\/mdw010","article-title":"A randomised clinical trial of neoadjuvant chemotherapy vs. neoadjuvant chemoradiotherapy for cancer of the oesophagus or gastro-oesophageal junction","volume":"27","author":"Klevebro","year":"2016","journal-title":"Ann Oncol"},{"key":"2021022314085024300_bjs10304-bib-0020","doi-asserted-by":"crossref","first-page":"851","DOI":"10.1200\/JCO.2008.17.0506","article-title":"Phase III comparison of preoperative chemotherapy compared with chemoradiotherapy in patients with locally advanced adenocarcinoma of the esophagogastric junction","volume":"27","author":"Stahl","year":"2009","journal-title":"J Clin Oncol"},{"key":"2021022314085024300_bjs10304-bib-0021","doi-asserted-by":"crossref","first-page":"2680","DOI":"10.1002\/1097-0142(19940601)73:11<2680::AID-CNCR2820731105>3.0.CO;2-C","article-title":"Pathologic assessment of tumor regression after preoperative chemoradiotherapy of esophageal carcinoma. Clinicopathologic correlations","volume":"73","author":"Mandard","year":"1994","journal-title":"Cancer"},{"key":"2021022314085024300_bjs10304-bib-0022","doi-asserted-by":"crossref","first-page":"2182","DOI":"10.1007\/s00268-006-0016-6","article-title":"Survival after neoadjuvant therapy compared with surgery alone for resectable esophageal cancer in a population-based study","volume":"30","author":"Rouvelas","year":"2006","journal-title":"World J Surg"},{"key":"2021022314085024300_bjs10304-bib-0023","first-page":"86","article-title":"Overall survival analysis of neoadjuvant chemoradiotherapy and esophagectomy for esophageal cancer","volume":"5","author":"Siddiqui","year":"2014","journal-title":"J Gastrointest Oncol"},{"key":"2021022314085024300_bjs10304-bib-0024","doi-asserted-by":"crossref","first-page":"1326","DOI":"10.1002\/bjs.10234","article-title":"Validation of data quality in the Swedish National Register for Oesophageal and Gastric Cancer","volume":"103","author":"Linder","year":"2016","journal-title":"Br J Surg"},{"key":"2021022314085024300_bjs10304-bib-0025","volume-title":"Esophageal and Gastric Cancer \u2013 National Treatment Guidelines","author":"Regionala Cancercentrum I Samverkan","year":"2016"},{"key":"2021022314085024300_bjs10304-bib-0026","first-page":"518","article-title":"Proposed classification of complications of surgery with examples of utility in cholecystectomy","volume":"111","author":"Clavien","year":"1992","journal-title":"Surgery"},{"key":"2021022314085024300_bjs10304-bib-0027","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1093\/bja\/78.2.228-a","article-title":"ASA classification and perioperative variables: graded anaesthesia score?","volume":"78","author":"Lake","year":"1997","journal-title":"Br J Anaesth"},{"key":"2021022314085024300_bjs10304-bib-0028","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1472-6947-13-72","article-title":"Appraisal of the Karnofsky Performance Status and proposal of a simple algorithmic system for its evaluation","volume":"13","author":"P\u00e9us","year":"2013","journal-title":"BMC Med Inform Decis Mak"},{"key":"2021022314085024300_bjs10304-bib-0029","doi-asserted-by":"crossref","first-page":"1471","DOI":"10.1245\/s10434-010-0985-4","article-title":"The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM","volume":"17","author":"Edge","year":"2010","journal-title":"Ann Surg Oncol"},{"key":"2021022314085024300_bjs10304-bib-0030","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1046\/j.1442-2050.2000.00101.x","article-title":"Prospective evaluation of preoperative chemotherapy in resectable squamous cell carcinoma of the thoracic esophagus","volume":"13","author":"Baba","year":"2000","journal-title":"Dis Esophagus"},{"key":"2021022314085024300_bjs10304-bib-0031","doi-asserted-by":"crossref","first-page":"5062","DOI":"10.1200\/JCO.2009.22.2083","article-title":"Long-term results of a randomized trial of surgery with or without preoperative chemotherapy in esophageal cancer","volume":"27","author":"Allum","year":"2009","journal-title":"J Clin Oncol"},{"key":"2021022314085024300_bjs10304-bib-0032","first-page":"391","article-title":"A prospective study of combined therapy in esophageal cancer","volume":"41","author":"Apinop","year":"1994","journal-title":"Hepatogastroenterology"},{"key":"2021022314085024300_bjs10304-bib-0033","doi-asserted-by":"crossref","first-page":"1104","DOI":"10.1007\/BF02067069","article-title":"Pre-operative radiotherapy prolongs survival in operable esophageal carcinoma: a randomized, multicenter study of pre-operative radiotherapy and chemotherapy. The second Scandinavian trial in esophageal cancer","volume":"16","author":"Nygaard","year":"1992","journal-title":"World J Surg"},{"key":"2021022314085024300_bjs10304-bib-0034","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1200\/JCO.2001.19.2.305","article-title":"Randomized trial of preoperative chemoradiation versus surgery alone in patients with locoregional esophageal carcinoma","volume":"19","author":"Urba","year":"2001","journal-title":"J Clin Oncol"},{"key":"2021022314085024300_bjs10304-bib-0035","doi-asserted-by":"crossref","first-page":"462","DOI":"10.1056\/NEJM199608153350702","article-title":"A comparison of multimodal therapy and surgery for esophageal adenocarcinoma","volume":"335","author":"Walsh","year":"1996","journal-title":"N Engl J Med"},{"key":"2021022314085024300_bjs10304-bib-0036","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1245\/s10434-011-2049-9","article-title":"A randomized trial comparing postoperative adjuvant chemotherapy with cisplatin and 5-fluorouracil versus preoperative chemotherapy for localized advanced squamous cell carcinoma of the thoracic esophagus (JCOG9907)","volume":"19","author":"Ando","year":"2012","journal-title":"Ann Surg Oncol"},{"key":"2021022314085024300_bjs10304-bib-0037","doi-asserted-by":"crossref","DOI":"10.1200\/jco.2014.32.15_suppl.tps4145","article-title":"ICORG 10-14: Neo-AEGIS: a randomized clinical trial of neoadjuvant and adjuvant chemotherapy (modified MAGIC regimen) versus neoadjuvant chemoradiation (CROSS protocol) in adenocarcinoma of the esophagus and esophagogastric junction","volume":"32","author":"Keegan","year":"2014","journal-title":"J Clin Oncol"},{"key":"2021022314085024300_bjs10304-bib-0038","doi-asserted-by":"crossref","first-page":"532","DOI":"10.1186\/s12885-015-1529-x","article-title":"TOPGEAR: a randomised phase III trial of perioperative ECF chemotherapy versus preoperative chemoradiation plus perioperative ECF chemotherapy for resectable gastric cancer (an international, intergroup trial of the AGITG\/TROG\/EORTC\/NCIC CTG)","volume":"15","author":"Leong","year":"2015","journal-title":"BMC Cancer"},{"key":"2021022314085024300_bjs10304-bib-0039","doi-asserted-by":"crossref","first-page":"786","DOI":"10.1097\/SLA.0000000000000965","article-title":"Lymph node retrieval during esophagectomy with and without neoadjuvant chemoradiotherapy: prognostic and therapeutic impact on survival","volume":"260","author":"Koen Talsma","year":"2014","journal-title":"Ann Surg"}],"container-title":["British Journal of Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fbjs.10304","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fbjs.10304","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/academic.oup.com\/bjs\/article-pdf\/103\/13\/1864\/36340780\/bjs10304.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/bjs\/article-pdf\/103\/13\/1864\/36340780\/bjs10304.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,5,20]],"date-time":"2021-05-20T14:17:12Z","timestamp":1621520232000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/bjs\/article\/103\/13\/1864-1873\/6136697"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,9,30]]},"references-count":39,"journal-issue":{"issue":"13","published-online":{"date-parts":[[2016,9,30]]},"published-print":{"date-parts":[[2016,11,30]]}},"URL":"https:\/\/doi.org\/10.1002\/bjs.10304","relation":{},"ISSN":["0007-1323","1365-2168"],"issn-type":[{"value":"0007-1323","type":"print"},{"value":"1365-2168","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2016,12]]},"published":{"date-parts":[[2016,9,30]]}}}