Evidence map›Paper›PMID 33249520›Full record

ArticleAnnals of surgical oncology2021

Effect of Extending the Original CROSS Criteria on Tumor Response to Neoadjuvant Chemoradiotherapy in Esophageal Cancer Patients: A National Multicenter Cohort Analysis.

Helena Hong Wang, Ellen C de Heer, Jan Binne Hulshoff, Gursah Kats-Ugurlu, Johannes G M Burgerhof, Boudewijn van Etten, John Th M Plukker, Geke A P Hospers, Dutch Upper Gastrointestinal Cancer Audit (DUCA) Group

Open access · hybridAbstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Annals of surgical oncology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.

0numbers the graph read from it
0cells of the map it votes in
9citing papers in PubMed
1.8field-weighted citation impact, top 14% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

9 citing papers in PubMed, 14 citations in OpenAlex.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors at 2 institutions in 1 country.

Helena Hong WangDepartment of Surgical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Ellen C de HeerDepartment of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Jan Binne HulshoffDepartment of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Gursah Kats-UgurluDepartment of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Johannes G M BurgerhofDepartment of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Boudewijn van EttenDepartment of Surgical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
John Th M PlukkerDepartment of Surgical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Geke A P HospersDepartment of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. g.a.p.hospers@umcg.nl.
Dutch Upper Gastrointestinal Cancer Audit (DUCA) Group
University Medical Center Groningen · NLUniversity of Groningen · NL

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundExtending the original criteria of the Chemoradiotherapy for Oesophageal Cancer followed by Surgery Study (CROSS) in daily practice may increase the treatment outcome of esophageal cancer (EC) patients. This retrospective national cohort study assessed the impact on the pathologic complete response (pCR) rate and surgical outcome. PATIENTS AND

methodsData from EC patients treated between 2009 and 2017 were collected from the national Dutch Upper Gastrointestinal Cancer Audit database. Patients had locally advanced EC (cT1/N+ or cT2-4a/N0-3/M0) and were treated according to the CROSS regimen. CROSS (n = 1942) and the extended CROSS (e-CROSS; n = 1359) represent patients fulfilling the original or extended CROSS criteria, respectively. The primary outcome was total pCR (ypT0N0), while secondary outcomes were local esophageal pCR (ypT0), surgical radicality, and postoperative morbidity and mortality.

resultsOverall, CROSS and e-CROSS did not differ in total or local pCR rate, although a trend was observed (23.2% vs. 20.4%, p = 0.052; and 26.7% vs. 23.8%, p = 0.061). When stratifying by histology, the pCR rate was higher in the CROSS group compared with e-CROSS in squamous cell carcinomas (48.2% vs. 33.3%, p = 0.000) but not in adenocarcinomas (16.8% vs. 16.9%, p = 0.908). Surgical radicality did not differ between groups. Postoperative mortality (3.2% vs. 4.6%, p = 0.037) and morbidity (58.3% vs. 61.8%, p = 0.048) were higher in e-CROSS.

conclusionExtending the CROSS inclusion criteria for neoadjuvant chemoradiotherapy in routine clinical practice of EC patients had no impact on the pCR rate and on radicality, but was associated with increased postoperative mortality and morbidity. Importantly, effects differed between histological subtypes. Hence, in future studies, we should carefully reconsider who will benefit most in the real-world setting.

Indexed as

Esophageal NeoplasmsNeoadjuvant TherapyChemoradiotherapyCohort StudiesEsophagectomyHumansRetrospective StudiesTreatment Outcome

Identifiers

PMID33249520
PMCPMC8184698
OpenAlexW3108917175

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.