TY - JOUR
T1 - Prognostic value of Mandard score and nodal status for recurrence patterns and survival after multimodal treatment of oesophageal adenocarcinoma
AU - Henckens, Sofie P. G.
AU - Liu, Dajia
AU - Gisbertz, Suzanne S.
AU - Kalff, Marianne C.
AU - Anderegg, Maarten C. J.
AU - Crull, David
AU - Daams, Freek
AU - van Dalsen, Annette D.
AU - Dekker, Jan Willem T.
AU - van Det, Marc J.
AU - van Duijvendijk, Peter
AU - Eshuis, Wietse J.
AU - Groenendijk, Richard P. R.
AU - Haveman, Jan Willem
AU - van Hillegersberg, Richard
AU - Luyer, Misha D. P.
AU - Olthof, Pim B.
AU - Pierie, Jean Pierre E. N.
AU - Plat, Victor D.
AU - Rosman, Camiel
AU - Ruurda, Jelle P.
AU - van Sandick, Johanna W.
AU - Sosef, Meindert N.
AU - Voeten, Daan M.
AU - Vijgen, Guy H. E. J.
AU - Bijlsma, Maarten F.
AU - Meijer, Sybren L.
AU - Hulshof, Maarten C. C. M.
AU - Oyarce, Cesar
AU - Lagarde, Sjoerd M.
AU - van Laarhoven, Hanneke W. M.
AU - van Berge Henegouwen, Mark I.
N1 - Publisher Copyright: © The Author(s) 2024.
PY - 2024/2/1
Y1 - 2024/2/1
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85185901289&partnerID=8YFLogxK
U2 - 10.1093/bjs/znae034
DO - 10.1093/bjs/znae034
M3 - Article
C2 - 38387083
SN - 0007-1323
VL - 111
JO - British Journal of Surgery
JF - British Journal of Surgery
IS - 2
M1 - znae034
ER -