TY  - JOUR
A1  - Davarzani, N
A1  - Hutchins, GGA
A1  - West, NP
A1  - Hewitt, LC
A1  - Nankivell, M
A1  - Cunningham, D
A1  - Allum, WH
A1  - Smyth, E
A1  - Valeri, N
A1  - Langley, RE
A1  - Grabsch, HI
JF  - Histopathology
UR  - http://dx.doi.org/10.1111/his.13491
SN  - 1365-2559
IS  - 7
N1  - 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.
VL  - 72
SP  - 1180
KW  - Carcinoma
KW  -  Chemotherapy
KW  -  Neoadjuvant
KW  -  Oesophageal
KW  -  Tumour regression grade
N2  - 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<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<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.
ID  - discovery10044327
AV  - public
Y1  - 2018/06//
EP  - 1188
TI  - Prognostic value of pathological lymph node status and primary tumour regression grading following neoadjuvant chemotherapy ? results from the MRC OE02 oesophageal cancer trial
ER  -