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Annals of Oncology Advance Access originally published online on January 22, 2009
Annals of Oncology 2009 20(5):885-891; doi:10.1093/annonc/mdn716
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© The Author 2009. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org

gastrointestinal tumors

The impact of primary tumour origins in patients with advanced oesophageal, oesophago–gastric junction and gastric adenocarcinoma—individual patient data from 1775 patients in four randomised controlled trials

I. Chau1, A. R. Norman2, D. Cunningham1,*, J. Oates1, R. Hawkins3, T. Iveson4, M. Nicolson5, P. Harper6, M. Seymour7 and T. Hickish8

1 Department of Medicine, Royal Marsden Hospital, London and Surrey
2 Department of Clinical Research and Development, Royal Marsden Hospital, Surrey
3 Department of Medical Oncology, The Christie Hospital, Manchester
4 Wessex Medical Oncology Unit, Southampton General Hospital, Southampton
5 Anchor Unit, Aberdeen Royal Infirmary, Aberdeen
6 Department of Medical Oncology, Guy's Hospital, London
7 Department of Medical Oncology, St James's Institute of Oncology, St James's University Hospital, Leeds
8 Oncology Department, Royal Bournemouth and Poole Hospital, Dorset

* Correspondence to: Prof. D. Cunningham, Department of Medicine, Royal Marsden Hospital, Downs Road, Sutton, Surrey SM2 5PT, UK. Tel: +44-208-661-3156; Fax: +44-208-643-9414; E-mail: david.cunningham{at}rmh.nhs.uk

Background: It is unclear if differential chemotherapy effects exist on overall survival (OS), response rate (RR) and toxicity depending on primary tumour origin [oesophageal versus oesophago–gastric junction (OGJ) versus gastric adenocarcinoma].

Patients and methods: A total of 2110 patients were enrolled in four randomised controlled trials (RCTs) assessing fluoropyrimidine ± platinum-based chemotherapy. This analysis used individual patient data and restricted to patients with adenocarcinoma who received one or more dose of chemotherapy. Gastric origin was the control in comparisons of tumour origin.

Results: Of the 2110 patients randomised, 1775 (84%) patients had adenocarcinoma with oesophageal (n = 485), OGJ (n = 457) and gastric (n = 833) origins. The median OS was 9.5 months in oesophageal, 9.3 months in OGJ and 8.7 months in gastric cancer (P = 0.68). RR was 44.1% in oesophageal, 41.1% in OGJ and 35.6% in gastric cancers (P = 0.11 and 0.27, respectively, compared with gastric cancer on multivariate analysis). Toxicity composite end point occurred in 46%, 47% and 45% in oesophageal, OGJ and gastric cancers, respectively (P = 0.85 and 0.62 compared with gastric).

Conclusions: In our large multicentre RCT dataset, no significant differences were demonstrated on multivariate analyses in OS, RR and toxic effects among patients with advanced oesophageal, OGJ and gastric adenocarcinoma. Future RCTs should not exclude oesophageal adenocarcinoma.

Key words: gastric adenocarcinoma, oesophagus, oesophago-gastric junction

Received for publication June 6, 2008. Revision received October 24, 2008. Accepted for publication October 27, 2008.


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