A multicentre cohort study to define and validate pathological assessment of response to neoadjuvant therapy in oesophagogastric adenocarcinoma
A multicentre cohort study to define and validate pathological assessment of response to neoadjuvant therapy in oesophagogastric adenocarcinoma
Background
This multicentre cohort study sought to define a robust pathological indicator of clinically meaningful response to neoadjuvant chemotherapy in oesophageal adenocarcinoma.
Methods
A questionnaire was distributed to 11 UK upper gastrointestinal cancer centres to determine the use of assessment of response to neoadjuvant chemotherapy. Records of consecutive patients undergoing oesophagogastric resection at seven centres between January 2000 and December 2013 were reviewed. Pathological response to neoadjuvant chemotherapy was assessed using the Mandard Tumour Regression Grade (TRG) and lymph node downstaging.
Results
TRG (8 of 11 centres) was the most widely used system to assess response to neoadjuvant chemotherapy, but there was discordance on how it was used in practice. Of 1392 patients, 1293 had TRG assessment; data were available for clinical and pathological nodal status (cN and pN) in 981 patients, and TRG, cN and pN in 885. There was a significant difference in survival between responders (TRG 1–2; median overall survival (OS) not reached) and non‐responders (TRG 3–5; median OS 2·22 (95 per cent c.i. 1·94 to 2·51) years; P < 0·001); the hazard ratio was 2·46 (95 per cent c.i. 1·22 to 4·95; P = 0·012). Among local non‐responders, the presence of lymph node downstaging was associated with significantly improved OS compared with that of patients without lymph node downstaging (median OS not reached versus 1·92 (1·68 to 2·16) years; P < 0·001).
Conclusion
A clinically meaningful local response to neoadjuvant chemotherapy was restricted to the small minority of patients (14·8 per cent) with TRG 1–2. Among local non‐responders, a subset of patients (21·3 per cent) derived benefit from neoadjuvant chemotherapy by lymph node downstaging and their survival mirrored that of local responders.
1816-1828
Noble, Fergus
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Lloyd, Megan
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Turkington, Richard
009673c1-0cfc-4ef0-b9c5-fd38a27f7596
Griffiths, Ewen
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O'Donovan, Maria
8e5376a9-2781-4d8c-9ffc-4c5f2a3ab7bc
O'Neill, Robert
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Mercer, Stuart
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Parsons, Simon
13a5869f-08a4-4664-8ce6-198ab46284a6
Fitzgerald, Rebecca
d50965b9-c99f-46dc-86d5-ff77f31ec73f
Underwood, Timothy
8e81bf60-edd2-4b0e-8324-3068c95ea1c6
December 2017
Noble, Fergus
4f14574c-28f2-4e04-bd95-f53c7649e1fa
Lloyd, Megan
5325a2c4-a0dc-4c99-88ad-a5adfab5c258
Turkington, Richard
009673c1-0cfc-4ef0-b9c5-fd38a27f7596
Griffiths, Ewen
e0ba23a0-f1d6-4e90-82d0-65fb9d06e1bf
O'Donovan, Maria
8e5376a9-2781-4d8c-9ffc-4c5f2a3ab7bc
O'Neill, Robert
85030795-4a84-420c-84fe-379dd3f94950
Mercer, Stuart
731e81ff-1fc6-41b3-808d-a7702a13bb66
Parsons, Simon
13a5869f-08a4-4664-8ce6-198ab46284a6
Fitzgerald, Rebecca
d50965b9-c99f-46dc-86d5-ff77f31ec73f
Underwood, Timothy
8e81bf60-edd2-4b0e-8324-3068c95ea1c6
Noble, Fergus, Lloyd, Megan, Turkington, Richard, Griffiths, Ewen, O'Donovan, Maria, O'Neill, Robert, Mercer, Stuart, Parsons, Simon, Fitzgerald, Rebecca and Underwood, Timothy
,
OCCAMS Consortium
(2017)
A multicentre cohort study to define and validate pathological assessment of response to neoadjuvant therapy in oesophagogastric adenocarcinoma.
British Journal of Surgery, 104 (13), .
(doi:10.1002/bjs.10627).
Abstract
Background
This multicentre cohort study sought to define a robust pathological indicator of clinically meaningful response to neoadjuvant chemotherapy in oesophageal adenocarcinoma.
Methods
A questionnaire was distributed to 11 UK upper gastrointestinal cancer centres to determine the use of assessment of response to neoadjuvant chemotherapy. Records of consecutive patients undergoing oesophagogastric resection at seven centres between January 2000 and December 2013 were reviewed. Pathological response to neoadjuvant chemotherapy was assessed using the Mandard Tumour Regression Grade (TRG) and lymph node downstaging.
Results
TRG (8 of 11 centres) was the most widely used system to assess response to neoadjuvant chemotherapy, but there was discordance on how it was used in practice. Of 1392 patients, 1293 had TRG assessment; data were available for clinical and pathological nodal status (cN and pN) in 981 patients, and TRG, cN and pN in 885. There was a significant difference in survival between responders (TRG 1–2; median overall survival (OS) not reached) and non‐responders (TRG 3–5; median OS 2·22 (95 per cent c.i. 1·94 to 2·51) years; P < 0·001); the hazard ratio was 2·46 (95 per cent c.i. 1·22 to 4·95; P = 0·012). Among local non‐responders, the presence of lymph node downstaging was associated with significantly improved OS compared with that of patients without lymph node downstaging (median OS not reached versus 1·92 (1·68 to 2·16) years; P < 0·001).
Conclusion
A clinically meaningful local response to neoadjuvant chemotherapy was restricted to the small minority of patients (14·8 per cent) with TRG 1–2. Among local non‐responders, a subset of patients (21·3 per cent) derived benefit from neoadjuvant chemotherapy by lymph node downstaging and their survival mirrored that of local responders.
Text
TRG Underwood_Revision1
- Accepted Manuscript
Text
Noble_et_al-2017-British_Journal_of_Surgery
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More information
Accepted/In Press date: 31 May 2017
e-pub ahead of print date: 25 September 2017
Published date: December 2017
Organisations:
Cancer Sciences
Identifiers
Local EPrints ID: 410973
URI: http://eprints.soton.ac.uk/id/eprint/410973
PURE UUID: 803ed7cc-d9e0-4621-8b02-c55527a45404
Catalogue record
Date deposited: 12 Jun 2017 16:31
Last modified: 16 Mar 2024 05:24
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Contributors
Author:
Fergus Noble
Author:
Megan Lloyd
Author:
Richard Turkington
Author:
Ewen Griffiths
Author:
Maria O'Donovan
Author:
Robert O'Neill
Author:
Stuart Mercer
Author:
Simon Parsons
Author:
Rebecca Fitzgerald
Corporate Author: OCCAMS Consortium
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