Dataset Information

Prognostic value of Mandard score and nodal status for recurrence patterns and survival after multimodal treatment of oesophageal adenocarcinoma.

ABSTRACT:

Background

This study evaluated the association of pathological tumour response (tumour regression grade, TRG) and a novel scoring system, combining both TRG and nodal status (TRG-ypN score; TRG1-ypN0, TRG>1-ypN0, TRG1-ypN+ and TRG>1-ypN+), with recurrence patterns and survival after multimodal treatment of oesophageal adenocarcinoma.

Methods

This Dutch nationwide cohort study included patients treated with neoadjuvant chemoradiotherapy followed by oesophagectomy for distal oesophageal or gastro-oesophageal junctional adenocarcinoma between 2007 and 2016. The primary endpoint was the association of Mandard score and TRG-ypN score with recurrence patterns (rate, location, and time to recurrence). The secondary endpoint was overall survival.

Results

Among 2746 inclusions, recurrence rates increased with higher Mandard scores (TRG1 30.6%, TRG2 44.9%, TRG3 52.9%, TRG4 61.4%, TRG5 58.2%; P < 0.001). Among patients with recurrent disease, the distribution (locoregional versus distant) was the same for the different TRG groups. Patients with TRG1 developed more brain recurrences (17.7 versus 9.8%; P = 0.001) and had a longer mean overall survival (44 versus 35 months; P < 0.001) than those with TRG>1. The TRG>1-ypN+ group had the highest recurrence rate (64.9%) and worst overall survival (mean 27 months). Compared with the TRG>1-ypN0 group, patients with TRG1-ypN+ had a higher risk of recurrence (51.9 versus 39.6%; P < 0.001) and worse mean overall survival (33 versus 41 months; P < 0.001).

Conclusion

Improved tumour response to neoadjuvant therapy was associated with lower recurrence rates and higher overall survival rates. Among patients with recurrent disease, TRG1 was associated with a higher incidence of brain recurrence than TRG>1. Residual nodal disease influenced prognosis more negatively than residual disease at the primary tumour site.

SUBMITTER: Henckens SPG

PROVIDER: S-EPMC10883709 | biostudies-literature | 2024 Jan

REPOSITORIES: biostudies-literature

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Publications

Prognostic value of Mandard score and nodal status for recurrence patterns and survival after multimodal treatment of oesophageal adenocarcinoma.

Henckens Sofie P G SPG Liu Dajia D Gisbertz Suzanne S SS Kalff Marianne C MC Anderegg Maarten C J MCJ Crull David D Daams Freek F van Dalsen Annette D AD Dekker Jan Willem T JWT van Det Marc J MJ van Duijvendijk Peter P Eshuis Wietse J WJ Groenendijk Richard P R RPR Haveman Jan Willem JW van Hillegersberg Richard R Luyer Misha D P MDP Olthof Pim B PB Pierie Jean-Pierre E N JEN Plat Victor D VD Rosman Camiel C Ruurda Jelle P JP van Sandick Johanna W JW Sosef Meindert N MN Voeten Daan M DM Vijgen Guy H E J GHEJ Bijlsma Maarten F MF Meijer Sybren L SL Hulshof Maarten C C M MCCM Oyarce Cesar C Lagarde Sjoerd M SM van Laarhoven Hanneke W M HWM van Berge Henegouwen Mark I MI

The British journal of surgery 20240101 2

<h4>Background</h4>This study evaluated the association of pathological tumour response (tumour regression grade, TRG) and a novel scoring system, combining both TRG and nodal status (TRG-ypN score; TRG1-ypN0, TRG>1-ypN0, TRG1-ypN+ and TRG>1-ypN+), with recurrence patterns and survival after multimodal treatment of oesophageal adenocarcinoma.<h4>Methods</h4>This Dutch nationwide cohort study included patients treated with neoadjuvant chemoradiotherapy followed by oesophagectomy for distal oesoph ...[more]

PMID: 38387083

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Project description:ObjectivesOesophageal adenocarcinoma has a poor prognosis and relies on multi-modality assessment for accurate nodal staging. The aim of the study was to determine the prognostic significance of nodal concordance between PET/CT and EUS in oesophageal adenocarcinoma.MethodsConsecutive patients with oesophageal adenocarcinoma staged between 2010 and 2016 were included. Groups comprising concordant node-negative (C-ve), discordant (DC), and concordant node-positive (C+ve) patients were analysed. Survival analysis using log-rank tests and Cox proportional hazards model was performed. The primary outcome was overall survival. A p value < 0.05 was considered statistically significant.ResultsIn total, 310 patients (median age = 66.0; interquartile range 59.5-72.5, males = 264) were included. The median overall survival was 23.0 months (95% confidence intervals (CI) 18.73-27.29). There was a significant difference in overall survival between concordance groups (X2 = 44.91, df = 2, p < 0.001). The hazard ratios for overall survival of DC and C+ve patients compared with those of C-ve patients with cT3 tumours were 1.21 (95% CI 0.81-1.79) and 1.79 (95% CI 1.23-2.61), respectively. On multivariable analysis, nodal concordance was significantly and independently associated with overall survival (HR 1.44, 95% CI 1.12-1.83, p = 0.004) and performed better than age at diagnosis (HR 1.02, 95% CI 1.003-1.034, p = 0.016) and current cN-staging methods (HR 1.20, 95% CI 0.978-1.48, p = 0.080).ConclusionsPatients with discordant nodal staging on PET/CT and EUS represent an intermediate-risk group for overall survival. This finding was consistent in patients with cT3 tumours. These findings will assist optimum treatment decisions based upon perceived prognosis for each patient.Key points• Clinicians are commonly faced with results of discordant nodal staging in oesophageal adenocarcinoma. • There is a significant difference in overall survival between patients with negative, discordant, and positive lymph node staging. • Patients with discordant lymph node staging between imaging modalities represent an intermediate-risk group for overall survival.

Dataset Information

Prognostic value of Mandard score and nodal status for recurrence patterns and survival after multimodal treatment of oesophageal adenocarcinoma.

Background

Methods

Results

Conclusion

Publications

Prognostic value of Mandard score and nodal status for recurrence patterns and survival after multimodal treatment of oesophageal adenocarcinoma.

Similar Datasets

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