eprintid: 10044327
rev_number: 32
eprint_status: archive
userid: 608
dir: disk0/10/04/43/27
datestamp: 2018-03-01 12:10:42
lastmod: 2021-12-13 02:43:06
status_changed: 2018-08-31 15:17:37
type: article
metadata_visibility: show
creators_name: Davarzani, N
creators_name: Hutchins, GGA
creators_name: West, NP
creators_name: Hewitt, LC
creators_name: Nankivell, M
creators_name: Cunningham, D
creators_name: Allum, WH
creators_name: Smyth, E
creators_name: Valeri, N
creators_name: Langley, RE
creators_name: Grabsch, HI
title: Prognostic value of pathological lymph node status and primary tumour regression grading following neoadjuvant chemotherapy – results from the MRC OE02 oesophageal cancer trial
ispublished: pub
divisions: UCL
divisions: B02
divisions: D65
divisions: J38
keywords: Carcinoma, Chemotherapy, Neoadjuvant, Oesophageal, Tumour regression grade
note: 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.
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<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.
date: 2018-06
date_type: published
official_url: http://dx.doi.org/10.1111/his.13491
oa_status: green
full_text_type: pub
language: eng
primo: open
primo_central: open_green
verified: verified_manual
elements_id: 1538271
doi: 10.1111/his.13491
lyricists_name: Langley, Ruth
lyricists_name: Nankivell, Matthew
lyricists_id: RELAN40
lyricists_id: MNANK23
actors_name: Flynn, Bernadette
actors_id: BFFLY94
actors_role: owner
full_text_status: public
publication: Histopathology
volume: 72
number: 7
pagerange: 1180-1188
event_location: England
issn: 1365-2559
citation:        Davarzani, N;    Hutchins, GGA;    West, NP;    Hewitt, LC;    Nankivell, M;    Cunningham, D;    Allum, WH;                 ... Grabsch, HI; + view all <#>        Davarzani, N;  Hutchins, GGA;  West, NP;  Hewitt, LC;  Nankivell, M;  Cunningham, D;  Allum, WH;  Smyth, E;  Valeri, N;  Langley, RE;  Grabsch, HI;   - view fewer <#>    (2018)    Prognostic value of pathological lymph node status and primary tumour regression grading following neoadjuvant chemotherapy – results from the MRC OE02 oesophageal cancer trial.                   Histopathology , 72  (7)   pp. 1180-1188.    10.1111/his.13491 <https://doi.org/10.1111/his.13491>.       Green open access   
 
document_url: https://discovery.ucl.ac.uk/id/eprint/10044327/7/Prognostic%20value%20of%20pathological%20lymph%20node%20status%20and%20primary%20tumour%20regression%20grading%20following%20neoadjuvant%20chemotherapy%20-%20results%20from%20the%20MRC%20OE02%20oesophageal%20cancer%20trial.pdf