@article{discovery10044327,
          volume = {72},
            note = {Copyright {\copyright} 2018 The Authors. Histopathology published by John Wiley \& Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits use, distribution and reproduction in any medium, provided the original work is properly cited.},
           pages = {1180--1188},
          number = {7},
           month = {June},
            year = {2018},
           title = {Prognostic value of pathological lymph node status and primary tumour regression grading following neoadjuvant chemotherapy - results from the MRC OE02 oesophageal cancer trial},
         journal = {Histopathology},
            issn = {1365-2559},
        abstract = {AIMS: Neoadjuvant chemotherapy (NAC) remains an important therapeutic option for advanced oesophageal cancer (OC). Pathological tumour regression grade (TRG) may offer additional information by directing adjuvant treatment and/or follow-up but clinical value remains unclear. We analysed the prognostic value of TRG and associated pathological factors in OC patients enrolled in the Medical Research Council OE02 trial. METHODS: Histopathology was reviewed in 497 resections from OE02 trial participants randomised to surgery (S-group;n=244) or NAC followed by surgery (CS-group;n=253). The association between TRG groups [responders (TRG1-3) versus non-responders (TRG4-5)], pathological lymph node (LN) status and overall survival (OS) was analysed. RESULTS: n=195/253(77\%) of CS patients were classified as 'non-responders' imparting a significantly higher mortality risk compared to responders, [hazard ratio (HR)=1.53, 95\% confidence interval (CI)=1.05-2.24, p=0.026]. OS was significantly better in patients without LN metastases irrespective of TRG [non-responders HR=1.87, 95\%CI=1.33-2.63, p{\ensuremath{<}}0.001 versus responders HR=2.21, 95\%CI=1.11-4.10), p=0.024]. In multivariate analyses, LN status was the only independent factor predictive of OS in CS patients (HR=1.93, 95\%CI=1.42-2.62, p{\ensuremath{<}}0.001). Exploratory subgroup analyses excluding radiotherapy-exposed patients (n=48) showed similar prognostic outcomes to primary analyses. CONCLUSION: LN status post-NAC is the most important prognostic factor, irrespective of TRG. Potential clinical implications e.g. adjuvant treatment or intensified follow-up, reinforce the importance of LN dissection for staging and prognostication. This article is protected by copyright. All rights reserved.},
          author = {Davarzani, N and Hutchins, GGA and West, NP and Hewitt, LC and Nankivell, M and Cunningham, D and Allum, WH and Smyth, E and Valeri, N and Langley, RE and Grabsch, HI},
             url = {http://dx.doi.org/10.1111/his.13491},
        keywords = {Carcinoma, Chemotherapy, Neoadjuvant, Oesophageal, Tumour regression grade}
}