Multicentre cohort study to define and validate pathological assessment of response to neoadjuvant therapy in oesophagogastric adenocarcinoma

Research output: Contribution to journalArticle

Authors

  • the OCCAMS consortium

Colleges, School and Institutes

External organisations

  • SOUTHAMPTON UNIVERSITY
  • Queen's University Belfast
  • University Hospitals Birmingham NHS Trust
  • University of Cambridge
  • Royal Infirmary of Edinburgh
  • Portsmouth Hospitals NHS Trust
  • Nottingham University Hospitals NHS Trust
  • Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
  • Imperial College London
  • Addenbrooke's Hospital
  • OXFORD UNIVERSITY
  • NHS Foundation Trust
  • University of Manchester
  • Royal Surrey County Hospital
  • University of Edinburgh
  • University Hospital Southampton

Abstract

Background: This multicentre cohort study sought to define a robust pathological indicator of clinically meaningful response to neoadjuvant chemotherapy in oesophageal adenocarcinoma. Methods: A questionnaire was distributed to 11 UK upper gastrointestinal cancer centres to determine the use of assessment of response to neoadjuvant chemotherapy. Records of consecutive patients undergoing oesophagogastric resection at seven centres between January 2000 and December 2013 were reviewed. Pathological response to neoadjuvant chemotherapy was assessed using the Mandard Tumour Regression Grade (TRG) and lymph node downstaging. Results: TRG (8 of 11 centres) was the most widely used system to assess response to neoadjuvant chemotherapy, but there was discordance on how it was used in practice. Of 1392 patients, 1293 had TRG assessment; data were available for clinical and pathological nodal status (cN and pN) in 981 patients, and TRG, cN and pN in 885. There was a significant difference in survival between responders (TRG 1–2; median overall survival (OS) not reached) and non-responders (TRG 3–5; median OS 2·22 (95 per cent c.i. 1·94 to 2·51) years; P < 0·001); the hazard ratio was 2·46 (95 per cent c.i. 1·22 to 4·95; P = 0·012). Among local non-responders, the presence of lymph node downstaging was associated with significantly improved OS compared with that of patients without lymph node downstaging (median OS not reached versus 1·92 (1·68 to 2·16) years; P < 0·001). Conclusion: A clinically meaningful local response to neoadjuvant chemotherapy was restricted to the small minority of patients (14·8 per cent) with TRG 1–2. Among local non-responders, a subset of patients (21·3 per cent) derived benefit from neoadjuvant chemotherapy by lymph node downstaging and their survival mirrored that of local responders.

Details

Original languageEnglish
Pages (from-to)1816-1828
Number of pages13
JournalBritish Journal of Surgery
Volume104
Issue number13
Publication statusPublished - Dec 2017

ASJC Scopus subject areas