Neoadjuvant chemoradiotherapy versus chemotherapy alone for locally advanced esophageal adenocarcinoma: A National Cancer Database analysis.

302 Background: The optimal neoadjuvant strategy for resectable, locally advanced esophageal adenocarcinoma (EAC) remains debated. While pivotal trials have established neoadjuvant chemoradiotherapy (nCRT) as a standard of care, several recent studies suggest that neoadjuvant chemotherapy (nCT) alone may offer similar survival with reduced toxicity. However, comparative effectiveness in a large, real-world U.S. population is unknown. We utilized a national database to compare outcomes between patients receiving nCRT and nCT. Methods: We identified patients in the National Cancer Database (NCDB) from 2010-2020 with clinical stage II/III (cT2-4aN0-3M0) EAC who underwent esophagectomy. Patients were categorized as receiving multi-agent nCT or nCRT. To minimize selection bias, we performed 1:1 propensity score matching (PSM) based on patient demographics, comorbidities (Charlson-Deyo score), and tumor characteristics (cT stage, cN stage, grade). The primary endpoints were pathologic complete response (pCR) rate and 5-year overall survival (OS). OS was analyzed using the Kaplan-Meier method and Cox proportional hazards regression. Results: Of 8,542 eligible patients, 6,120 (71.6%) received nCRT and 2,422 (28.4%) received nCT. After PSM, 2,000 well-matched pairs were identified (Table 1). In the matched cohort, the pCR rate was significantly higher in the nCRT group compared to the nCT group (28.5% vs. 9.8%, p