Refining pathological evaluation of neoadjuvant therapy for adenocarcinoma of the esophagus
Refining pathological evaluation of neoadjuvant therapy for adenocarcinoma of the esophagus
AIM: To assess tumour regression grade (TRG) and lymph node downstaging to help define patients who benefit from neoadjuvant chemotherapy.
METHODS: Two hundred and eighteen consecutive patients with adenocarcinoma of the esophagus or gastro-esophageal junction treated with surgery alone or neoadjuvant chemotherapy and surgery between 2005 and 2011 at a single institution were reviewed. Triplet neoadjuvant chemotherapy consisting of platinum, fluoropyrimidine and anthracycline was considered for operable patients (World Health Organization performance status ? 2) with clinical stage T2-4 N0-1. Response to neoadjuvant chemotherapy (NAC) was assessed using TRG, as described by Mandard et al. In addition lymph node downstaging was also assessed. Lymph node downstaging was defined by cN1 at diagnosis: assessed radiologically (computed tomography, positron emission tomography, endoscopic ultrasonography), then pathologically recorded as N0 after surgery; ypN0 if NAC given prior to surgery, or pN0 if surgery alone. Patients were followed up for 5 years post surgery. Recurrence was defined radiologically, with or without pathological confirmation. An association was examined between t TRG and lymph node downstaging with disease free survival (DFS) and a comprehensive range of clinicopathological characteristics.
RESULTS: Two hundred and eighteen patients underwent esophageal resection during the study interval with a mean follow up of 3 years (median follow up: 2.552, 95%CI: 2.022-3.081). There was a 1.8% (n = 4) inpatient mortality rate. One hundred and thirty-six (62.4%) patients received NAC, with 74.3% (n = 101) of patients demonstrating some signs of pathological tumour regression (TRG 1-4) and 5.9% (n = 8) having a complete pathological response. Forty four point one percent (n = 60) had downstaging of their nodal disease (cN1 to ypN0), compared to only 15.9% (n = 13) that underwent surgery alone (pre-operatively overstaged: cN1 to pN0), (P < 0.0001). Response to NAC was associated with significantly increased DFS (mean DFS; TRG 1-2: 5.1 years, 95%CI: 4.6-5.6 vs TRG 3-5: 2.8 years, 95%CI: 2.2-3.3, P < 0.0001). Nodal down-staging conferred a significant DFS advantage for those patients with a poor primary tumour response to NAC (median DFS; TRG 3-5 and nodal down-staging: 5.533 years, 95%CI: 3.558-7.531 vs TRG 3-5 and no nodal down-staging: 1.114 years, 95%CI: 0.961-1.267, P < 0.0001).
CONCLUSION: Response to NAC in the primary tumour and in the lymph nodes are both independently associated with improved DFS.
esophageal cancer, gastro-esophageal cancer, neoadjuvant, regression
9282-9293
Noble, Fergus
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Nolan, Luke
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Bateman, Adrian C.
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Byrne, James
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Kelly, Jamie
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Bailey, Ian
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Sharland, Donna
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Rees, Charlotte
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Iveson, T.
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Underwood, T.J.
8e81bf60-edd2-4b0e-8324-3068c95ea1c6
Bateman, Andrew R.
a851558d-8b9b-4020-b148-a239c2b26815
28 December 2013
Noble, Fergus
4f14574c-28f2-4e04-bd95-f53c7649e1fa
Nolan, Luke
b93be062-e519-4677-a708-a0d2c26acd24
Bateman, Adrian C.
28ae82e3-b93a-429a-81f5-04e8f1ff4cc7
Byrne, James
e3d5b8fe-1b69-441c-a173-e084fe5372a6
Kelly, Jamie
c8b841fe-7134-4332-b453-5dc8c76058a5
Bailey, Ian
635ff85d-4492-45be-bdf5-b54a2762a703
Sharland, Donna
b9b42e9d-8ad2-4bb0-bd98-32dccfa2ad2a
Rees, Charlotte
03bd79ab-ad28-4cbb-91a8-053c9d2f9a3b
Iveson, T.
867cb6c5-ea9a-4521-a4cc-4cd4d2503b3a
Underwood, T.J.
8e81bf60-edd2-4b0e-8324-3068c95ea1c6
Bateman, Andrew R.
a851558d-8b9b-4020-b148-a239c2b26815
Noble, Fergus, Nolan, Luke, Bateman, Adrian C., Byrne, James, Kelly, Jamie, Bailey, Ian, Sharland, Donna, Rees, Charlotte, Iveson, T., Underwood, T.J. and Bateman, Andrew R.
(2013)
Refining pathological evaluation of neoadjuvant therapy for adenocarcinoma of the esophagus.
World Journal of Gastroenterology, 19 (48), .
(doi:10.3748/wjg.v19.i48.9282).
Abstract
AIM: To assess tumour regression grade (TRG) and lymph node downstaging to help define patients who benefit from neoadjuvant chemotherapy.
METHODS: Two hundred and eighteen consecutive patients with adenocarcinoma of the esophagus or gastro-esophageal junction treated with surgery alone or neoadjuvant chemotherapy and surgery between 2005 and 2011 at a single institution were reviewed. Triplet neoadjuvant chemotherapy consisting of platinum, fluoropyrimidine and anthracycline was considered for operable patients (World Health Organization performance status ? 2) with clinical stage T2-4 N0-1. Response to neoadjuvant chemotherapy (NAC) was assessed using TRG, as described by Mandard et al. In addition lymph node downstaging was also assessed. Lymph node downstaging was defined by cN1 at diagnosis: assessed radiologically (computed tomography, positron emission tomography, endoscopic ultrasonography), then pathologically recorded as N0 after surgery; ypN0 if NAC given prior to surgery, or pN0 if surgery alone. Patients were followed up for 5 years post surgery. Recurrence was defined radiologically, with or without pathological confirmation. An association was examined between t TRG and lymph node downstaging with disease free survival (DFS) and a comprehensive range of clinicopathological characteristics.
RESULTS: Two hundred and eighteen patients underwent esophageal resection during the study interval with a mean follow up of 3 years (median follow up: 2.552, 95%CI: 2.022-3.081). There was a 1.8% (n = 4) inpatient mortality rate. One hundred and thirty-six (62.4%) patients received NAC, with 74.3% (n = 101) of patients demonstrating some signs of pathological tumour regression (TRG 1-4) and 5.9% (n = 8) having a complete pathological response. Forty four point one percent (n = 60) had downstaging of their nodal disease (cN1 to ypN0), compared to only 15.9% (n = 13) that underwent surgery alone (pre-operatively overstaged: cN1 to pN0), (P < 0.0001). Response to NAC was associated with significantly increased DFS (mean DFS; TRG 1-2: 5.1 years, 95%CI: 4.6-5.6 vs TRG 3-5: 2.8 years, 95%CI: 2.2-3.3, P < 0.0001). Nodal down-staging conferred a significant DFS advantage for those patients with a poor primary tumour response to NAC (median DFS; TRG 3-5 and nodal down-staging: 5.533 years, 95%CI: 3.558-7.531 vs TRG 3-5 and no nodal down-staging: 1.114 years, 95%CI: 0.961-1.267, P < 0.0001).
CONCLUSION: Response to NAC in the primary tumour and in the lymph nodes are both independently associated with improved DFS.
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Published date: 28 December 2013
Keywords:
esophageal cancer, gastro-esophageal cancer, neoadjuvant, regression
Organisations:
Cancer Sciences
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Local EPrints ID: 360912
URI: http://eprints.soton.ac.uk/id/eprint/360912
ISSN: 1007-9327
PURE UUID: 4e8fc6a4-8da3-4b38-b346-82d48702204f
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Date deposited: 08 Jan 2014 14:10
Last modified: 15 Mar 2024 03:17
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Author:
Fergus Noble
Author:
Luke Nolan
Author:
Adrian C. Bateman
Author:
James Byrne
Author:
Jamie Kelly
Author:
Ian Bailey
Author:
Donna Sharland
Author:
Charlotte Rees
Author:
Andrew R. Bateman
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