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Prognostic value of pathological lymph node status and primary tumour regression grading following neoadjuvant chemotherapy – results from the MRC OE 02 oesophageal cancer trial
Author(s) -
Davarzani Nasser,
Hutchins Gordon G A,
West Nicholas P,
Hewitt Lindsay C,
Nankivell Matthew,
Cunningham David,
Allum William H,
Smyth Elizabeth,
Valeri Nicola,
Langley Ruth E,
Grabsch Heike I
Publication year - 2018
Publication title -
histopathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.626
H-Index - 124
eISSN - 1365-2559
pISSN - 0309-0167
DOI - 10.1111/his.13491
Subject(s) - medicine , hazard ratio , confidence interval , chemotherapy , lymph node , gastroenterology , proportional hazards model , neoadjuvant therapy , cancer , grading (engineering) , pathological , radiation therapy , oncology , surgery , breast cancer , civil engineering , engineering
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 its clinical value remains unclear. We analysed the prognostic value of TRG and associated pathological factors in OC patients enrolled in the Medical Research Council (MRC) OE 02 trial. Methods and results Histopathology was reviewed in 497 resections from OE 02 trial participants randomised to surgery (S group; n = 244) or NAC followed by surgery [chemotherapy plus surgery ( CS ) group; n = 253]. The association between TRG groups [responders ( TRG 1–3) versus non‐responders ( TRG 4–5)], pathological lymph node ( LN ) status and overall survival ( OS ) was analysed. One hundred and ninety‐five of 253 (77%) CS patients were classified as ‘non‐responders’, with 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. Conclusion Lymph node status post‐ NAC is the most important prognostic factor in patients with resectable oesophageal cancer, irrespective of TRG . Potential clinical implications, e.g. adjuvant treatment or intensified follow‐up, reinforce the importance of LN dissection for staging and prognostication.