@article{JGO121743,
author = {Sabrina Schaefer and Sindhu Kanjeekal and Tarek Elfiki and John Mathews and Akmal Ghafoor and Abdullah Nasser},
title = {Nodal status and advanced clinical stage as determinants of response and survival after induction chemoradiotherapy in esophageal and gastroesophageal junction cancer: a single-centre retrospective cohort study},
journal = {Journal of Gastrointestinal Oncology},
volume = {17},
number = {4},
year = {2026},
keywords = {},
abstract = {Background: Induction (neoadjuvant) chemoradiotherapy based on the CROSS regimen (weekly carboplatin/paclitaxel with concurrent radiation) is a standard of care for resectable esophageal and gastroesophageal junction (GEJ) cancer. However, the pivotal trials enrolled predominantly cT2–3 tumors with limited nodal involvement, did not stratify by nodal status, and largely excluded cT4, cN2–3, and oligometastatic (cM1) disease. Because these higher-risk patients are common in routine practice yet under-represented in trials, real-world data are needed to clarify how baseline nodal and clinical-stage affect outcomes after CROSS-based treatment. We evaluated the association between baseline clinical-stage and outcomes following CROSS-based treatment in a real-world cohort.Methods: We performed a single-centre retrospective cohort study of consecutive patients treated with CROSS-based induction chemoradiotherapy [weekly carboplatin area under the curve (AUC) =2 and paclitaxel 50 mg/m2 with concurrent 41.4 Gy] for esophageal/GEJ cancer between 2012 and 2022 at a Canadian regional cancer centre. Patients were identified from institutional pathology and systemic-therapy databases, cross-referenced with electronic records, and stratified a priori by initial clinical staging: group 1 (cT1–3N0M0), group 2 (cT1–3N1M0), and group 3 (cT4 and/or cN2–3 and/or oligometastatic cM1), the latter largely excluded from CROSS-based trials. Overall survival (OS) and progression-free survival (PFS), both measured from diagnosis, were primary outcomes; resection rate and pathologic complete response (pCR) were secondary. Survival was estimated using Kaplan-Meier methods and compared with log-rank testing; multivariable Cox models adjusted for age, sex, and Eastern Cooperative Oncology Group (ECOG) status, with two-sided statistical significance defined as P},
issn = {2219-679X}, url = {https://jgo.amegroups.org/article/view/121743}
}