Impact of neoadjuvant chemotherapy on nodal regression and survival in oesophageal adenocarcinoma |
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| Affiliation: | 1. Department of Upper Gastrointestinal Surgery, University Hospitals Birmingham NHS Foundation Trust, UK;2. Institute of Immunology and Immunotherapy, University of Birmingham, UK;3. Institute of Cancer and Genomic Science, University of Birmingham, UK;4. Department of Oncology, University Hospitals Birmingham NHS Foundation Trust, UK;5. Department of Pathology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK;6. Department of Pathology, San Bortolo Hospital, Vicenza, Italy;1. Fiona Stanley Hospital, Western Australia, Australia;2. Department of General Surgery, St. James''s Hospital, Dublin 8, Ireland;3. Peter MacCallum Cancer Centre, Melbourne, Australia;4. Department of Urology, Tallaght University Hospital, Dublin 24, Ireland;5. Department of Surgery, University College London, London, UK;6. Altnagelvin Hospital, Derry, Northern Ireland, UK;1. Department of General Surgery, Guy''s and St Thomas'' NHS Trust, London, UK;2. Department of General Surgery, Queen Alexandra Hospital, Portsmouth University Hospital NHS Trust, Portsmouth, UK;3. Department of General Surgery, Oxford University Hospital NHS Foundation Trust, Oxford, UK;4. School of Cancer Sciences, Faculty of Medicine, University of Southampton, UK;5. School of Cancer and Pharmaceutical Sciences, King''s College London, London, UK;6. Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden;1. Sarcoma, Melanoma and Rare Tumors Surgery Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy;2. Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy;3. Business Controlling Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy;1. Department of Orthopaedic Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands;2. Department of Surgical Oncology, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands;3. Department of Surgical Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, the Netherlands;4. Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands;5. Department of Surgical Oncology, Radboud University Hospital, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands;6. Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, United Kingdom;7. Division of Clinical Oncology, Medical University of Graz, Graz, Austria;8. Department of Orthopedics, Lund University, Skåne University Hospital, Lund, Sweden;9. Department of Orthopedic Surgery, Sarcoma Centre of Aarhus University Hospital, Aarhus, Denmark;10. Helse Bergen Haukeland University Hospital, Jonas Lies vei 65, 5021, Bergen, Norway;11. Norwegian Radium University Hospital, Postboks 4950 Nydalen, 0424, Oslo, Norway;1. Department of Surgery, Franciscus Gasthuis & Vlietland, Rotterdam, Schiedam, the Netherlands;2. Department of Surgery, division of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands;3. Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, the Netherlands;4. Department of Research & Development, Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands;5. Department of Surgery, IJsselland Hospital, Capelle aan den IJssel, the Netherlands;6. Department of Surgery, division of Surgical Oncology, Radboud University Medical Centre, Nijmegen, the Netherlands;1. Washington Cancer Institute, Program in Peritoneal Surface Malignancy Washington, DC, USA;2. Westat, Rockville, MD, USA |
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| Abstract: | ![]()
BackgroundThe prognostic value of lymph node regression (LNR) following neoadjuvant chemotherapy (nCT) for oesophageal and gastro-oeosphageal adenocarcinoma remains unclear. This study aimed to characterise the long-term survival outcomes of LNR in patients having resectional surgery after nCT.MethodsThis study included patients undergoing oesophagectomy or extended total gastrectomy for oesophageal and junctional tumours (Siewert types 1,2,3) at the Queen Elizabeth Hospital Birmingham from 2012 to 2018. Lymph nodes retrieved at surgery were examined 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 with either partial or no response.ResultsThis study identified 183 patients who received nCT, of which 71% (130/183) had positive lymph nodes. Of these 130 patients, 44% (57/130) had a lymph node response and 56% (73/130) did not. The remaining 53 patients (29.0%) had negative lymph nodes with no evidence of tumour. Lymph node responders had a significant survival benefit compared to patients without lymph node response, but shorter than those with negative lymph nodes (median: 27 vs 18 vs NR months, p < 0·001). On multivariable analysis, lymph node responders had an improved overall (Hazard ratio (HR): 0.86, 95% CI: 0.80–0.92, p < 0.001) and recurrence-free (HR: 0.90, 95% CI: 0.82–0.98, p = 0.030) survival.ConclusionLymph node regression is an important prognostic factor, warranting closer evaluation over primary tumour response to help with planning further adjuvant therapy in these patients. |
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| Keywords: | Lymph node regression Neoadjuvant chemotherapy Oesophageal adenocarcinoma |
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