Davarzani, N;
Hutchins, GGA;
West, NP;
Hewitt, LC;
Nankivell, M;
Cunningham, D;
Allum, WH;
... Grabsch, HI; + view all
(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.
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Prognostic value of pathological lymph node status and primary tumour regression grading following neoadjuvant chemotherapy - results from the MRC OE02 oesophageal cancer trial.pdf - Published Version Download (383kB) | Preview |
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.
| Type: | Article |
|---|---|
| Title: | Prognostic value of pathological lymph node status and primary tumour regression grading following neoadjuvant chemotherapy – results from the MRC OE02 oesophageal cancer trial |
| Location: | England |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1111/his.13491 |
| Publisher version: | http://dx.doi.org/10.1111/his.13491 |
| Language: | English |
| Additional information: | 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. |
| Keywords: | Carcinoma, Chemotherapy, Neoadjuvant, Oesophageal, Tumour regression grade |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology > MRC Clinical Trials Unit at UCL |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10044327 |
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