Prognostic value of pathological lymph node status and primary tumour regression grading following neoadjuvant chemotherapy - results from the MRC OE02 oesophageal cancer trial.

摘要: Aims: Neoadjuvant chemotherapy (NAC) remains an important therapeutic option for advanced oesophageal cancer (OC). Pathological tumour regression grade (TRG) may offer additional information by directing adjuvant treatment and/or follow-up but its clinical value unclear. We analysed the prognostic of TRG and associated pathological factors in OC patients enrolled Medical Research Council (MRC) OE02 trial. Methods results: Histopathology was reviewed 497 resections from trial participants randomised to surgery (S group; n = 244) or NAC followed [chemotherapy plus (CS) 253]. The association between groups [responders (TRG1-3) versus non-responders (TRG4-5)], lymph node (LN) status overall survival (OS) analysed. One hundred ninety-five 253 (77%) CS were classified as 'non-responders', with a significantly higher mortality risk compared responders [hazard ratio (HR) 1.53, 95% confidence interval (CI) 1.05-2.24, P 0.026]. OS better without LN metastases irrespective [non-responders HR 1.87, CI 1.33-2.63, < 0.001 2.21, 1.11-4.10, 0.024]. In multivariate analyses, only independent factor predictive (HR 1.93, 1.42-2.62, 0.001). Exploratory subgroup analyses excluding radiotherapy-exposed (n 48) showed similar outcomes. Conclusion: Lymph post-NAC is most resectable cancer, TRG. Potential implications, e.g. intensified follow-up, reinforce importance dissection staging prognostication.