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

Author:

Noble F1,Lloyd M A1,Turkington R2,Griffiths E3,O'Donovan M4,O'Neill J R5,Mercer S6,Parsons S L7,Fitzgerald R C4,Underwood T J1ORCID,Noorani A8,Fels Elliott R8,Abdullahi Z8,de la Rue R8,Bornschein J8,MacRae S8,Nutzinger B8,Grehan N8,Contino G8,Crawte J8,Edwards P A W8,Miremadi A9,Malhotra S9,Hayden A1,Walker R1,Peters C10,Hannah G10,Hardwick R11,Davies J12,Ford H13,Gilligan D13,Safranek P13,Hindmarsh A13,Sujendran V13,Carroll N13,McManus D2,Hayes S J1415,Ang Y1617,Preston S R18,Oakes S18,Bagwan I18,Skipworth R J E19,Save V19,Hupp T R20,Puig S21,Bedford M21,Taniere P21,Whiting J21,Byrne J22,Kelly J22,Owsley J22,Crichton C23,Barr H24,Shepherd N24,Old O24,Lagergren J2526,Gossage J25,Davies A25,Chang F25,Zylstra J25,Sanders G27,Berrisford R27,Harden C27,Bunting D27,Lewis M28,Cheong E28,Kumar B28,Saunders J H29,Soomro I N29,Vohra R29,Duffy J29,Kaye P29,Grabowska A29,Lovat L30,Haidry R30,Eneh V30,Igali L31,Welch I32,Scott M32,Sothi S33,Suortamo S33,Lishman S34,Beardsmore D35,Sutaria R36,Secrier M17,Eldridge M D17,Bower L17,Lynch A G17,Tavaré S17

Affiliation:

1. Cancer Sciences Unit, University of Southampton, Southampton, UK

2. Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast, UK

3. Department of Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK

4. Hutchison/Medical Research Council Cancer Unit, University of Cambridge, Cambridge, UK

5. Department of Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK

6. Department of Surgery, Portsmouth NHS Trust, Portsmouth, UK

7. Department of Surgery, Nottingham University Hospitals NHS Trust, Nottingham, UK

8. Medical Research Council Cancer Unit, Hutchison/Medical Research Council Research Centre, University of Cambridge, Cambridge, UK

9. Department of Histopathology, Cambridge University Hospital NHS Trust, Cambridge, UK

10. Imperial College, London, UK

11. Oesophago-Gastric Unit, Addenbrooke's Hospital, Cambridge, UK

12. Oxford ComLab, University of Oxford, Oxford, UK

13. Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK

14. Salford Royal NHS Foundation Trust, Salford

15. Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK

16. Salford Royal NHS Foundation Trust, Salford, Leigh NHS Foundation Trust, Wigan

17. Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK

18. Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK

19. Edinburgh Royal Infirmary, Edinburgh, UK

20. Edinburgh University, Edinburgh, UK

21. University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK

22. University Hospital Southampton NHS Foundation Trust, Southampton, UK

23. Department of Computer Science, University of Oxford, Oxford, UK

24. Gloucester Royal Hospital, Gloucester, UK

25. St Thomas's Hospital and King's College London, London, UK

26. Karolinska Institute, Stockholm, Sweden

27. Plymouth Hospitals NHS Trust, Plymouth, UK

28. Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK

29. Nottingham University Hospitals NHS Trust, Nottingham, UK

30. University College London, London, UK

31. Norfolk and Waveney Cellular Pathology Network, Norwich, UK

32. Wythenshawe Hospital, Manchester, UK

33. University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK

34. Peterborough City Hospital, Peterborough Hospitals NHS Trust, Peterborough, UK

35. Royal Stoke University Hospital, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK

36. PortsmouthNHSTrust, Portsmouth, UK

Abstract

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.

Funder

Medical Research Council Clinician Scientist Fellowship

Cancer Research UK

National Institute for Health Research Cambridge Biomedical Research Centre

Experimental Cancer Medicine Centre

Publisher

Oxford University Press (OUP)

Subject

Surgery

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