Multicentre cohort study to define and validate pathological assessment of response to neoadjuvant therapy in oesophagogastric adenocarcinoma-Reference-Cited by-同舟云学术

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

Published:2017-09-25 Issue:13 Volume:104 Page:1816-1828
ISSN:0007-1323
Container-title:British Journal of Surgery
language:en
Short-container-title:

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 J¹^ORCID,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

Link

http://academic.oup.com/bjs/article-pdf/104/13/1816/36206975/bjs10627.pdf

Reference34 articles.