TY - JOUR
T1 - Does a high Mandard score really define a poor response to chemotherapy in oesophageal adenocarcinoma?
AU - on behalf of the Guy’s & St Thomas’ Oesophago-Gastric Research Group
AU - Knight, William R.C.
AU - Baker, Cara R.
AU - Griffin, Nyree
AU - Wulaningsih, Wahyu
AU - Kelly, Mark
AU - Davies, Andrew R.
AU - Gossage, James A.
AU - Hynes, O.
AU - Tham, G.
AU - Iezzi, C.
AU - Bott, R.
AU - Maisey, N.
AU - Gaya, A.
AU - Ngan, S.
AU - Qureshi, A.
AU - Green, M.
AU - Jacques, A.
AU - Goh, V.
AU - Deere, H.
AU - Chang, F.
AU - Mahadeva, U.
AU - Gill-Barman, B.
AU - George, S.
AU - Dunn, J.
AU - Zeki, S.
AU - Meenan, J.
N1 - Publisher Copyright:
© 2021, Crown.
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/5/11
Y1 - 2021/5/11
N2 - Background: A high Mandard score implies a non-response to chemotherapy in oesophageal adenocarcinoma. However, some patients exhibit tumour volume reduction and a nodal response despite a high score. This study examines survival and recurrence patterns in these patients. Methods: Clinicopathological factors were analysed using multivariable Cox regression assessing time to death and recurrence. Computed tomography-estimated tumour volume change was examined in a subgroup of consecutive patients. Results: Five hundred and fifty-five patients were included. Median survival was 55 months (Mandard 1–3) and 21 months (Mandard 4 and 5). In the Mandard 4 and 5 group (332 patients), comparison between complete nodal responders and persistent nodal disease showed improved survival (90 vs 18 months), recurrence rates (locoregional 14.75 vs 28.74%, systemic 24.59 vs 48.42%) and circumferential resection margin positivity (22.95 vs 68.11%). Complete nodal response independently predicted improved survival (hazard ratio 0.34 (0.16–0.74). Post-chemotherapy tumour volume reduction was greater in patients with a complete nodal response (−16.3 vs −7.7 cm3, p = 0.033) with no significant difference between Mandard groups. Conclusion: Patients with a complete nodal response to chemotherapy have significantly improved outcomes despite a poor Mandard score. High Mandard score does not correspond with a non-response to chemotherapy in all cases and patients with nodal downstaging may still benefit from adjuvant chemotherapy.
AB - Background: A high Mandard score implies a non-response to chemotherapy in oesophageal adenocarcinoma. However, some patients exhibit tumour volume reduction and a nodal response despite a high score. This study examines survival and recurrence patterns in these patients. Methods: Clinicopathological factors were analysed using multivariable Cox regression assessing time to death and recurrence. Computed tomography-estimated tumour volume change was examined in a subgroup of consecutive patients. Results: Five hundred and fifty-five patients were included. Median survival was 55 months (Mandard 1–3) and 21 months (Mandard 4 and 5). In the Mandard 4 and 5 group (332 patients), comparison between complete nodal responders and persistent nodal disease showed improved survival (90 vs 18 months), recurrence rates (locoregional 14.75 vs 28.74%, systemic 24.59 vs 48.42%) and circumferential resection margin positivity (22.95 vs 68.11%). Complete nodal response independently predicted improved survival (hazard ratio 0.34 (0.16–0.74). Post-chemotherapy tumour volume reduction was greater in patients with a complete nodal response (−16.3 vs −7.7 cm3, p = 0.033) with no significant difference between Mandard groups. Conclusion: Patients with a complete nodal response to chemotherapy have significantly improved outcomes despite a poor Mandard score. High Mandard score does not correspond with a non-response to chemotherapy in all cases and patients with nodal downstaging may still benefit from adjuvant chemotherapy.
UR - http://www.scopus.com/inward/record.url?scp=85103180950&partnerID=8YFLogxK
U2 - 10.1038/s41416-021-01290-4
DO - 10.1038/s41416-021-01290-4
M3 - Article
AN - SCOPUS:85103180950
SN - 0007-0920
VL - 124
SP - 1653
EP - 1660
JO - British journal of cancer
JF - British journal of cancer
IS - 10
ER -
