Lymph node regression and survival following neoadjuvant chemotherapy in oesophageal adenocarcinoma

A. R. Davies; D. Myoteri; J. Zylstra; C. R. Baker; W. Wulaningsih; M. Van Hemelrijck; N. Maisey; W. H. Allum; E. Smyth; J. A. Gossage; J. Lagergren; D. Cunningham; M. Green; M. Kelly; S. Ngan; A. Qureshi; A. Gaya; N. Griffin; A. Jacques; V. Goh; H. Deere; F. Chang; U. Mahadeva; B. Gill-Barman; S. George; J. Dunn; S. Zeki; J. Meenan; O. Hynes; G. Tham; C. Iezzi; D. Dellaportas; A. Cowie; W. Knight; N. Valeri; the Guy's and St Thomas' Oesophago-Gastric Research Group and PROGRESS Study Group

doi:10.1002/bjs.10900

Lymph node regression and survival following neoadjuvant chemotherapy in oesophageal adenocarcinoma

A. R. Davies^*, D. Myoteri, J. Zylstra, C. R. Baker, W. Wulaningsih, M. Van Hemelrijck, N. Maisey, W. H. Allum, E. Smyth, J. A. Gossage, J. Lagergren, D. Cunningham, M. Green, M. Kelly, S. Ngan, A. Qureshi, A. Gaya, N. Griffin, A. Jacques, V. GohH. Deere, F. Chang, U. Mahadeva, B. Gill-Barman, S. George, J. Dunn, S. Zeki, J. Meenan, O. Hynes, G. Tham, C. Iezzi, D. Dellaportas, A. Cowie, W. Knight, N. Valeri, the Guy's and St Thomas' Oesophago-Gastric Research Group and PROGRESS Study Group

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Abstract

Background: The aim was to define the pathological response in lymph nodes following neoadjuvant chemotherapy for oesophageal adenocarcinoma and to quantify any associated survival benefit. Methods: Lymph nodes retrieved at oesophagectomy were examined retrospectively by two pathologists for evidence of a response to chemotherapy. Patients were classified as lymph node-negative (either negative nodes with no evidence of previous tumour involvement or negative with evidence of complete regression) or positive (allocated a lymph node regression score based on the proportion of fibrosis to residual tumour). Lymph node responders (score 1, complete response; 2, less than 10 per cent remaining tumour; 3, 10–50 per cent remaining tumour) and non-responders (score 4, more than 50 per cent viable tumour; 5, no response) were compared in survival analyses using Kaplan–Meier and Cox regression analysis. Results: Among 377 patients, 256 had neoadjuvant chemotherapy. Overall, 68 of 256 patients (26·6 per cent) had a lymph node response and 115 (44·9 per cent) did not. The remaining 73 patients (28·5 per cent) had negative lymph nodes with no evidence of regression. Some patients had a lymph node response in the absence of a response in the primary tumour (27 of 99, 27 per cent). Lymph node responders had a significant survival benefit (P < 0·001), even when stratified by patients with or without a response in the primary tumour. On multivariable analysis, lymph node responders had decreased overall (hazard ratio 0·53, 95 per cent c.i. 0·36 to 0·78) and disease-specific (HR 0·42, 0·27 to 0·66) mortality, and experienced reduced local and systemic recurrence. Conclusion: Lymph node regression is a strong prognostic factor and may be more important than response in the primary tumour.

Original language	English
Pages (from-to)	1639-1649
Number of pages	11
Journal	British Journal of Surgery
Volume	105
Issue number	12
Early online date	22 Jul 2018
DOIs	https://doi.org/10.1002/bjs.10900
Publication status	Published - 1 Nov 2018

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Davies, A. R., Myoteri, D., Zylstra, J., Baker, C. R., Wulaningsih, W., Van Hemelrijck, M., Maisey, N., Allum, W. H., Smyth, E., Gossage, J. A., Lagergren, J., Cunningham, D., Green, M., Kelly, M., Ngan, S., Qureshi, A., Gaya, A., Griffin, N., Jacques, A., ... the Guy's and St Thomas' Oesophago-Gastric Research Group and PROGRESS Study Group (2018). Lymph node regression and survival following neoadjuvant chemotherapy in oesophageal adenocarcinoma. British Journal of Surgery, 105(12), 1639-1649. https://doi.org/10.1002/bjs.10900

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title = "Lymph node regression and survival following neoadjuvant chemotherapy in oesophageal adenocarcinoma",

abstract = "Background: The aim was to define the pathological response in lymph nodes following neoadjuvant chemotherapy for oesophageal adenocarcinoma and to quantify any associated survival benefit. Methods: Lymph nodes retrieved at oesophagectomy were examined retrospectively by two pathologists for evidence of a response to chemotherapy. Patients were classified as lymph node-negative (either negative nodes with no evidence of previous tumour involvement or negative with evidence of complete regression) or positive (allocated a lymph node regression score based on the proportion of fibrosis to residual tumour). Lymph node responders (score 1, complete response; 2, less than 10 per cent remaining tumour; 3, 10–50 per cent remaining tumour) and non-responders (score 4, more than 50 per cent viable tumour; 5, no response) were compared in survival analyses using Kaplan–Meier and Cox regression analysis. Results: Among 377 patients, 256 had neoadjuvant chemotherapy. Overall, 68 of 256 patients (26·6 per cent) had a lymph node response and 115 (44·9 per cent) did not. The remaining 73 patients (28·5 per cent) had negative lymph nodes with no evidence of regression. Some patients had a lymph node response in the absence of a response in the primary tumour (27 of 99, 27 per cent). Lymph node responders had a significant survival benefit (P < 0·001), even when stratified by patients with or without a response in the primary tumour. On multivariable analysis, lymph node responders had decreased overall (hazard ratio 0·53, 95 per cent c.i. 0·36 to 0·78) and disease-specific (HR 0·42, 0·27 to 0·66) mortality, and experienced reduced local and systemic recurrence. Conclusion: Lymph node regression is a strong prognostic factor and may be more important than response in the primary tumour.",

author = "Davies, {A. R.} and D. Myoteri and J. Zylstra and Baker, {C. R.} and W. Wulaningsih and {Van Hemelrijck}, M. and N. Maisey and Allum, {W. H.} and E. Smyth and Gossage, {J. A.} and J. Lagergren and D. Cunningham and M. Green and M. Kelly and S. Ngan and A. Qureshi and A. Gaya and N. Griffin and A. Jacques and V. Goh and H. Deere and F. Chang and U. Mahadeva and B. Gill-Barman and S. George and J. Dunn and S. Zeki and J. Meenan and O. Hynes and G. Tham and C. Iezzi and D. Dellaportas and A. Cowie and W. Knight and N. Valeri and {the Guy's and St Thomas' Oesophago-Gastric Research Group and PROGRESS Study Group}",

year = "2018",

month = nov,

day = "1",

doi = "10.1002/bjs.10900",

language = "English",

volume = "105",

pages = "1639--1649",

journal = "British Journal of Surgery",

issn = "0007-1323",

publisher = "John Wiley & Sons, Ltd",

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Davies, AR, Myoteri, D, Zylstra, J , Baker, CR , Wulaningsih, W , Van Hemelrijck, M, Maisey, N, Allum, WH, Smyth, E, Gossage, JA , Lagergren, J, Cunningham, D, Green, M, Kelly, M, Ngan, S, Qureshi, A, Gaya, A, Griffin, N, Jacques, A, Goh, V, Deere, H, Chang, F, Mahadeva, U, Gill-Barman, B, George, S, Dunn, J, Zeki, S, Meenan, J, Hynes, O, Tham, G, Iezzi, C, Dellaportas, D, Cowie, A, Knight, W, Valeri, N & the Guy's and St Thomas' Oesophago-Gastric Research Group and PROGRESS Study Group 2018, 'Lymph node regression and survival following neoadjuvant chemotherapy in oesophageal adenocarcinoma', British Journal of Surgery, vol. 105, no. 12, pp. 1639-1649. https://doi.org/10.1002/bjs.10900

TY - JOUR

T1 - Lymph node regression and survival following neoadjuvant chemotherapy in oesophageal adenocarcinoma

AU - Davies, A. R.

AU - Myoteri, D.

AU - Zylstra, J.

AU - Baker, C. R.

AU - Wulaningsih, W.

AU - Van Hemelrijck, M.

AU - Maisey, N.

AU - Allum, W. H.

AU - Smyth, E.

AU - Gossage, J. A.

AU - Lagergren, J.

AU - Cunningham, D.

AU - Green, M.

AU - Kelly, M.

AU - Ngan, S.

AU - Qureshi, A.

AU - Gaya, A.

AU - Griffin, N.

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.

AU - Hynes, O.

AU - Tham, G.

AU - Iezzi, C.

AU - Dellaportas, D.

AU - Cowie, A.

AU - Knight, W.

AU - Valeri, N.

AU - the Guy's and St Thomas' Oesophago-Gastric Research Group and PROGRESS Study Group

PY - 2018/11/1

Y1 - 2018/11/1

N2 - Background: The aim was to define the pathological response in lymph nodes following neoadjuvant chemotherapy for oesophageal adenocarcinoma and to quantify any associated survival benefit. Methods: Lymph nodes retrieved at oesophagectomy were examined retrospectively by two pathologists for evidence of a response to chemotherapy. Patients were classified as lymph node-negative (either negative nodes with no evidence of previous tumour involvement or negative with evidence of complete regression) or positive (allocated a lymph node regression score based on the proportion of fibrosis to residual tumour). Lymph node responders (score 1, complete response; 2, less than 10 per cent remaining tumour; 3, 10–50 per cent remaining tumour) and non-responders (score 4, more than 50 per cent viable tumour; 5, no response) were compared in survival analyses using Kaplan–Meier and Cox regression analysis. Results: Among 377 patients, 256 had neoadjuvant chemotherapy. Overall, 68 of 256 patients (26·6 per cent) had a lymph node response and 115 (44·9 per cent) did not. The remaining 73 patients (28·5 per cent) had negative lymph nodes with no evidence of regression. Some patients had a lymph node response in the absence of a response in the primary tumour (27 of 99, 27 per cent). Lymph node responders had a significant survival benefit (P < 0·001), even when stratified by patients with or without a response in the primary tumour. On multivariable analysis, lymph node responders had decreased overall (hazard ratio 0·53, 95 per cent c.i. 0·36 to 0·78) and disease-specific (HR 0·42, 0·27 to 0·66) mortality, and experienced reduced local and systemic recurrence. Conclusion: Lymph node regression is a strong prognostic factor and may be more important than response in the primary tumour.

AB - Background: The aim was to define the pathological response in lymph nodes following neoadjuvant chemotherapy for oesophageal adenocarcinoma and to quantify any associated survival benefit. Methods: Lymph nodes retrieved at oesophagectomy were examined retrospectively by two pathologists for evidence of a response to chemotherapy. Patients were classified as lymph node-negative (either negative nodes with no evidence of previous tumour involvement or negative with evidence of complete regression) or positive (allocated a lymph node regression score based on the proportion of fibrosis to residual tumour). Lymph node responders (score 1, complete response; 2, less than 10 per cent remaining tumour; 3, 10–50 per cent remaining tumour) and non-responders (score 4, more than 50 per cent viable tumour; 5, no response) were compared in survival analyses using Kaplan–Meier and Cox regression analysis. Results: Among 377 patients, 256 had neoadjuvant chemotherapy. Overall, 68 of 256 patients (26·6 per cent) had a lymph node response and 115 (44·9 per cent) did not. The remaining 73 patients (28·5 per cent) had negative lymph nodes with no evidence of regression. Some patients had a lymph node response in the absence of a response in the primary tumour (27 of 99, 27 per cent). Lymph node responders had a significant survival benefit (P < 0·001), even when stratified by patients with or without a response in the primary tumour. On multivariable analysis, lymph node responders had decreased overall (hazard ratio 0·53, 95 per cent c.i. 0·36 to 0·78) and disease-specific (HR 0·42, 0·27 to 0·66) mortality, and experienced reduced local and systemic recurrence. Conclusion: Lymph node regression is a strong prognostic factor and may be more important than response in the primary tumour.

UR - http://www.scopus.com/inward/record.url?scp=85054604851&partnerID=8YFLogxK

U2 - 10.1002/bjs.10900

DO - 10.1002/bjs.10900

M3 - Article

C2 - 30047556

AN - SCOPUS:85054604851

SN - 0007-1323

VL - 105

SP - 1639

EP - 1649

JO - British Journal of Surgery

JF - British Journal of Surgery

IS - 12

ER -

Lymph node regression and survival following neoadjuvant chemotherapy in oesophageal adenocarcinoma

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