PD01.05. Preoperative Response to FLOT and Pathologic and Survival Outcomes in Gastroesophageal Adenocarcinoma

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ID: 325714
2026
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Ranked #5 of 453 articles by views in diseases of the esophagus : official journal of the international society for diseases of the esophagus

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Abstract
Abstract Topic Esophageal Cancer: Adjuvant and Neo-Adjuvant Therapies Background Perioperative 5-fluorouracil, leucovorin, oxaliplatin, and docetaxel (FLOT) is standard of care in resectable gastroesophageal adenocarcinoma (GEA). Pre-operative staging and re-staging computed tomography (CT) or positron emission tomography (PET) can determine tumour response to FLOT before surgery, affecting decision-making surrounding adjuvant chemotherapy. This study aimed to determine whether pre-operative response to FLOT was associated with pathologic and survival outcomes. Methods Patients with GEA who received neoadjuvant FLOT and subsequently underwent surgery from January 2017 to April 2025 at University Health Network (UHN), Canada, were retrospectively analysed. Staging and re-staging CT and PET were used to determine GEA response to FLOT, patients were then separated into FLOT responders (FR) or non-responders (FNR). Pathologic and overall (OS) and disease-free survival (DFS) outcomes were compared between the two groups. Results 169 patients were included for final analysis, of which 116 (68.6%) were FR and 53 (31.4%) were FNR. Median follow-up was 24 months. The FR group had better ECOG status, less advanced ypT and ypN stage, greater tumor response to neoadjuvant treatment, and lower rates of lymphovascular and perineural invasion. Median OS was higher in the FR group (67 vs. 43.8 months, log rank p=0.016). Median DFS was higher in the FR group (32 vs. 20 months, log rank p=0.018). Pre-operative FLOT response was not a predictor of OS (p=0.101) or DFS (p=0.196) on multivariable analysis. Conclusion Patients who demonstrated pre-operative radiologic or metabolic response to FLOT had more favourable pathologic measures and superior OS and DFS on univariate analysis. This survival advantage was not seen on multivariable analysis. Non-response to FLOT in the preoperative setting can inform decision-making regarding adjuvant systemic therapy, with a potential to pivot.
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Authors Jin-soo Park, Frances Allison, Jonathan Allen, Raymond Jang, Lucy Ma, Carly Barron, Elena Elimova, Jelena Lukovic, Aruz Mesci, Rebecca Wong, Patrik Rogalla, Patrick Veit-Haibach, Fayez Quereshy, Karineh Kazazian, Carol Swallow, Jonathan Yeung, Elliot Wakeam
Journal diseases of the esophagus : official journal of the international society for diseases of the esophagus
Year 2026
DOI
10.1093/dote/doag077.075
URL
https://doi.org/10.1093/dote/doag077.075
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