Association of waiting time from diagnosis to neoadjuvant chemoradiotherapy on interval distant metastases in esophageal cancer patients: A study based on the Netherlands cancer registry

Abstract

Introduction

In patients with resectable esophageal cancer, interval distant metastases may be detected following neoadjuvant-intent chemoradiotherapy ((n)CRT). The specific association between the waiting time from diagnosis to the initiation of (n)CRT and interval metastases remains unclear.

Methods

Patients with esophageal cancer (cT1-4a N0-3 M0) received CRT with or without surgery were extracted from the Netherlands Cancer Registry. Multivariable logistic and cox regression analyses were used to compare different waiting times (≤4, 4–8 and >8weeks) on the risk of interval metastases, post-(n)CRT short-term metastases (detected preoperatively, intraoperatively, or postoperatively within 120 days after CROSS regimen CRT) and overall survival (OS). Subgroup analysis based on cN stage was performed.

Results

Between 2015 and 2021, a total of 4394 patients were included. Compared to the waiting ≤4 weeks, the waiting >8 weeks was associated with higher risk of interval metastases (p-value = 0.045),but the longer waiting times were not associated with higher risk of post-(n)CRT short-term metastases or worse OS. In the cN0 subgroup, compared to the waiting ≤4 weeks, the waiting 4–8weeks (p-value = 0.049; p-value = 0.046) and >8 weeks (p-value = 0.006; p-value = 0.006) was associated with higher risk of interval metastases and post-(n)CRT short-term metastases, but was not associated with worse OS. In the cN + subgroup, the longer waiting times were not associated with interval metastases or post-(n)CRT short-term metastases or OS.

Conclusion

A longer waiting time from diagnosis to the initiation of (n)CRT was associated with a higher risk of interval metastases, but not with an increased risk of post-(n)CRT short-term metastases or worse OS.