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

作者：Fergus Noble, Megan A. Lloyd, Richard Calvin Turkington, Ewen Alexander Griffiths, Maria O’Donovan, J. Robert O’Neill, S. J. Mercer, Simon L. Parsons, Rebecca C. Fitzgerald, Tim Underwood, A Noorani, Rachael Fels Elliott, Zarah Abdullahi, Rachel de la Rue, Jan Bornschein, Shona MacRae, Barbara Nutzinger, Nicola Grehan, Gianmarco Contino, Jason Crawte, Paul A. Edwards, Ahmad Miremadi, Shalini Malhotra, Annette L. Hayden, Rob F. Walker, Christopher John Peters, George Hannah, Richard Henry Hardwick, J Davies, Hugo E. R. Ford, DAVID M. GILLIGAN, Peter M. Safranek, Andrew Hindmarsh, Vijay Sujendran, Nicholas R. Carroll, Damien McManus, Stephen J. Hayes, Yeng Shiong Ang, Shaun R. Preston, Sarah Oakes, Izhar Bagwan, Richard J.E. Skipworth, Vicki Save, Ted R. Hupp, Susana Puig, M Bedford, Philippe Tanière, J Whiting, James Patrick Byrne, Jamie J. Kelly, Jack Owsley, Charles Crichton, H. Barr, Neil A. Shepherd, Oliver J. Old, Jesper Lagergren, J. A. Gossage, Andrew John Davies, Fuju Chang, Janine Zylstra, Grant Sanders, Richard G Berrisford, Christopher Harden, David Bunting, Michael P. Lewis, E Cheong, Bhaskar Kumar, James H. Saunders, Irshad Nabi Soomro, Ravinder Vohra, John P. Duffy, Philip Kaye, Anna M. Grabowska, Laurence B. Lovat, Rehan J. Haidry, Victoria Eneh, Laszlo Igali, I. Welch, Michael E Scott, Sharmila Sothi, Sari Suortamo, Suzy Lishman, Duncan Beardsmore, Rupesh Sutaria, Maria Secrier, Matthew Eldridge, Lawrence Bower, Andy G. Lynch, Simon Tavaré · 发表于：British journal of surgery · 年份：2017 · DOI：10.1002/bjs.10627 · 被引用次数：108 · 研究领域：Esophageal Cancer Research and Treatment、Gastric Cancer Management and Outcomes、Pancreatic and Hepatic Oncology Research

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 ...