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• W2024453564 abstract "S 743 will be cost-effective if the incidence of EAC in BE is > 1.9 per 100 patients-years. Actual data show an incidence between 0.12-1.1 per 100 patients-years. Risk stratification to determine who would benefit most from this approach is arguably the most important future advance regarding surveillance and would markedly improve the cost-effectiveness of this approach (individualized surveillance intervals). Specific clinical factors and molecular biomarkers may play a role on this assessment. Recently, Sikkema et al. found that the risk of developing ACA is predominantly determined by the presence of LGD, a known duration of BE > 10 years, longer length of BE and the presence of esophagitis. Focusing efforts on individuals with risk would be a more efficient use of resources. 38. Neoadjuvant studies in upper gastro-intestinal cancers C. Mariette 1 Centre Hospitalier Huriez, Department of Digestive and Oncologica Surgery, Lille, France The prognosis of locally advanced upper gastro-intestinal cancer remains poor [1, 2]. It has been shown that multimodal treatment can improve the outcome in comparison to surgery alone [1, 2]. In oesophageal carcinomas, a recent meta-analysis of 24 randomised studies with 4188 patients enrolled [3] provides strong evidence for a survival benefit of neoadjuvant chemoradiotherapy (HR 0.78 (95% CI 0.70-0.88); p<0.0001) or chemotherapy (0.87 (0.79-0.96); p1⁄40.005) over surgery alone. Survival advantage of neoadjuvant chemoradiotherapy was noted for both squamous-cell carcinoma (HR 0.80 (0.68-0.93); p1⁄40.004) and adenocarcinoma (HR 0.75 (0.59-0.95); p1⁄40.02), whereas a survival advantage of neoadjuvant chemotherapy was found only for adenocarcinoma (HR 0.83 (0.71-0.95); p1⁄40.01 vs. HR 0.92 (0.81-1.04); p1⁄40.18 for squamous cell carcinoma). A clear advantage of neoadjuvant chemoradiotherapy over neoadjuvant chemotherapy has not been clearly established (HR 0.88 (0.76-1.01); p1⁄40.07). Whereas the survival advantage of neoadjuvant treatment is clearly established for locally advanced tumours, no benefit is found when comparing chemoradiation over surgery alone in a recent randomized trial including only early oesophageal cancers (stages I and II), with a higher postoperative mortality risk [4]. Regarding gastric cancers, two European randomized studies have shown that peri-operative chemotherapy significantly improves the survival of patients with adenocarcinoma of the stomach and of the gastroesophageal junction [5, 6]. Neither mortality nor complication rate are increased after neoadjuvant chemotherapy for gastric cancer. These results have a profound effect on the treatment of patients presenting with stage II or stage III disease. Moreover, for more than 10 years it has been accepted that responding patients have a significantly improved prognosis compared to non-responding patients. These results should help inform decisions about patient management and design of future trials." @default.
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• W2024453564 title "38. Neoadjuvant studies in upper gastro-intestinal cancers" @default.
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