TY - JOUR
T1 - Pathologic Lymph Node Regression After Neoadjuvant Chemotherapy Predicts Recurrence and Survival in Esophageal Adenocarcinoma
T2 - A Multicenter Study in the United Kingdom
AU - The Oesophageal Cancer Clinical and Molecular Stratification (OCCAMS) study group, The Guy's and St Thomas' Oesophago-gastric Research Group, and The PROGRESS study group
AU - Moore, Jonathan L.
AU - Green, Michael
AU - Santaolalla, Aida
AU - Deere, Harriet
AU - Evans, Richard P.T.
AU - Elshafie, Mona
AU - Lavery, Anita
AU - McManus, Damian T.
AU - McGuigan, Andrew
AU - Douglas, Rosalie
AU - Horne, Joanne
AU - Walker, Robert
AU - Mir, Hira
AU - Terlizzo, Monica
AU - Kamarajah, Sivesh K.
AU - Van Hemelrijck, Mieke
AU - Maisey, Nick
AU - Sita-Lumsden, Ailsa
AU - Ngan, Sarah
AU - Kelly, Mark
AU - Baker, Cara R.
AU - Kumar, Sacheen
AU - Lagergren, Jesper
AU - Allum, William H.
AU - Gossage, James A.
AU - Griffiths, Ewen A.
AU - Grabsch, Heike I.
AU - Turkington, Richard C.
AU - Underwood, Tim J.
AU - Smyth, Elizabeth C.
AU - Fitzgerald, Rebecca C.
AU - Cunningham, David
AU - Davies, Andrew R.
N1 - Publisher Copyright:
© American Society of Clinical Oncology.
PY - 2023/10/1
Y1 - 2023/10/1
N2 - Purpose: There is limited evidence regarding the prognostic effects of pathologic lymph node (LN) regression after neoadjuvant chemotherapy for esophageal adenocarcinoma, and a definition of LN response is lacking. This study aimed to evaluate how LN regression influences survival after surgery for esophageal adenocarcinoma.Methods: Multicenter cohort study of patients with esophageal adenocarcinoma treated with neoadjuvant chemotherapy followed by surgical resection at five high-volume centers in the United Kingdom. LNs retrieved at esophagectomy were examined for chemotherapy response and given a LN regression score (LNRS)—LNRS 1, complete response; 2, <10% residual tumor; 3, 10%-50% residual tumor; 4, >50% residual tumor; and 5, no response. Survival analysis was performed using Cox regression adjusting for confounders including primary tumor regression. The discriminatory ability of different LN response classifications to predict survival was evaluated using Akaike information criterion and Harrell C-index.Results: In total, 17,930 LNs from 763 patients were examined. LN response classified as complete LN response (LNRS 1 ≥1 LN, no residual tumor in any LN; n = 62, 8.1%), partial LN response (LNRS 1-3 ≥1 LN, residual tumor ≥1 LN; n = 155, 20.3%), poor/no LN response (LNRS 4-5; n = 303, 39.7%), or LN negative (no tumor/regression; n = 243, 31.8%) demonstrated superior discriminatory ability. Mortality was reduced in patients with complete LN response (hazard ratio [HR], 0.35; 95% CI, 0.22 to 0.56), partial LN response (HR, 0.72; 95% CI, 0.57 to 0.93) or negative LNs (HR, 0.32; 95% CI, 0.25 to 0.42) compared with those with poor/no LN response. Primary tumor regression and LN regression were discordant in 165 patients (21.9%).Conclusion: Pathologic LN regression after neoadjuvant chemotherapy was a strong prognostic factor and provides important information beyond pathologic TNM staging and primary tumor regression grading. LN regression should be included as standard in the pathologic reporting of esophagectomy specimens.
AB - Purpose: There is limited evidence regarding the prognostic effects of pathologic lymph node (LN) regression after neoadjuvant chemotherapy for esophageal adenocarcinoma, and a definition of LN response is lacking. This study aimed to evaluate how LN regression influences survival after surgery for esophageal adenocarcinoma.Methods: Multicenter cohort study of patients with esophageal adenocarcinoma treated with neoadjuvant chemotherapy followed by surgical resection at five high-volume centers in the United Kingdom. LNs retrieved at esophagectomy were examined for chemotherapy response and given a LN regression score (LNRS)—LNRS 1, complete response; 2, <10% residual tumor; 3, 10%-50% residual tumor; 4, >50% residual tumor; and 5, no response. Survival analysis was performed using Cox regression adjusting for confounders including primary tumor regression. The discriminatory ability of different LN response classifications to predict survival was evaluated using Akaike information criterion and Harrell C-index.Results: In total, 17,930 LNs from 763 patients were examined. LN response classified as complete LN response (LNRS 1 ≥1 LN, no residual tumor in any LN; n = 62, 8.1%), partial LN response (LNRS 1-3 ≥1 LN, residual tumor ≥1 LN; n = 155, 20.3%), poor/no LN response (LNRS 4-5; n = 303, 39.7%), or LN negative (no tumor/regression; n = 243, 31.8%) demonstrated superior discriminatory ability. Mortality was reduced in patients with complete LN response (hazard ratio [HR], 0.35; 95% CI, 0.22 to 0.56), partial LN response (HR, 0.72; 95% CI, 0.57 to 0.93) or negative LNs (HR, 0.32; 95% CI, 0.25 to 0.42) compared with those with poor/no LN response. Primary tumor regression and LN regression were discordant in 165 patients (21.9%).Conclusion: Pathologic LN regression after neoadjuvant chemotherapy was a strong prognostic factor and provides important information beyond pathologic TNM staging and primary tumor regression grading. LN regression should be included as standard in the pathologic reporting of esophagectomy specimens.
UR - http://www.scopus.com/inward/record.url?scp=85172739951&partnerID=8YFLogxK
U2 - 10.1200/JCO.23.00139
DO - 10.1200/JCO.23.00139
M3 - Article
C2 - 37499209
AN - SCOPUS:85172739951
SN - 0732-183X
VL - 41
SP - 4522
EP - 4534
JO - Journal of Clinical Oncology
JF - Journal of Clinical Oncology
IS - 28
ER -
