A pathological study of tumour regression in oesophageal adenocarcinoma treated with preoperative chemoradiotherapy

Abstract

Aims-To measure residual tumour in oesophageal adenocarcinoma treated with preoperative chemoradiotherapy, to correlate specific pathological variables with survival, and to describe morphological changes in tumour and non-neoplastic tissue resulting from preoperative treatment. Methods-Resection specimens from 47 cases of oesophageal adenocarcinoma treated with preoperative 5-fluorouracil/ cisplatin and radiotherapy were reviewed. Residual tumour was assessed in terms of tumour regression grade (TRG), pTNM stage, lymphovascular space invasion, and resection margin involvement. Survival analysis was performed using the KaplanMeier method and log rank test. Cox's proportional hazard model was used for multivariate analysis. Results-A complete pathological response (TRG1) was present in eight cases. The absence of residual tumour was confirmed by negative immunohistochemical staining for MNF116. Tumour corresponding to TRG2 was present in five cases, to TRG3 in nine, to TRG4 in 22, and to TRG5 in three. By multivariate analysis, pN0 status (n = 35) had a positive eVect on survival (p = 0.04) and TRG had no significant eVect on survival (p = 0.06). Patients with pN0 tumours had a median survival of 48 months versus eight months for those with pN1 tumours (log rank test, p < 0.0001). We found that giant fibroblasts were discernible from single large residual tumour cells on haematoxylin and eosin alone. Conclusion-Response to preoperative chemoradiotherapy in oesophageal adenocarcinoma is variable. Although there are as yet no reliable predictors of response to treatment, patients who are identified at diagnosis as having negative loco-regional lymph nodes should benefit considerably from this treatment approach. (J Clin Pathol 2001;54:841-845)

Postoperative Chemotherapy May Not Be Necessary for Patients With ypN0-Category After Neoadjuvant Chemoradiotherapy of Rectal Cancer

“…But this hypothesis was not confirmed by the analysis of Medich et al 7 There also is a relationship to be found between the prognosis and the lymph node status in the neoadjuvant treatment of organ tumors, as for instance in gastric carcinoma 35 or esophageal carcinoma 36 .…”

Prognostic significance of histopathological tumor regression after neoadjuvant chemotherapy in esophageal adenocarcinomas

“…These changes generally represent a pattern of subacute inflammation, and in addition decreased tumor cell density, acellular mucus lakes, foamy histiocytes, fibrosis (especially in the submucosa and muscularis propria), dissolution of glands, giant cells, and cytological changes, such as apoptotic bodies and intracellular vacuoles. 8,12,16 Furthermore, tumor regression showed a centrifugal pattern with tumorfree fibrosis in the central and superficial, luminal portions of the tumor bed and residual tumor in deeper areas of the periphery; although tumor regression was associated with tumor downstaging of the ypT category in more than half of the patients, the remaining tumors with a partial regression (tumor regression grade 2) still had a ypT3 category. These findings confirm the need to work-up the whole tumor bed to detect scattered tumor residuals that are important for determining an accurate tumor category and regression classification.…”

“…19,20 Moreover, a high inter-observer reliability for those systems has been shown, with those systems equally applicable to both squamous cell carcinoma and adenocarcinoma. 21 After 15 years of diagnostic experience, we favor this scoring system in clinical practice over the widely used regression system described by Dunne et al 16 and Mandard et al, 22 which includes five tumor regression grades, based on the percentage of residual tumor in relation to therapy-induced fibrosis. A scoring system of three grades seems to be more easily implemented, more reproducible, and stronger and clearer with regard to prognostic impact.…”

Prognosis of esophageal squamous cell carcinoma patients with preoperative radiotherapy: Comparison of different cancer staging systems

“…A study that included 47 esophageal adenocarcinoma cases with preoperative therapy found that the involvement of local lymph nodes is the only relevant factor related to prognosis. 13 Retrospective analyses by Gu et al included 187 patients with adenocarcinoma in the lower esophagus or esophagogastric junction, all of whom received preoperative radiochemotherapy. In cases with more than two positive lymph nodes, the median survival time and overall survival are significantly lower than those with only one positive lymph node (47.1 months vs. 21.2 months, 34% vs. 6%, P = 0.02).…”