Prognostic value of histopathological regression in 850 neoadjuvantly treated oesophagogastric adenocarcinomas

Abstract

Background:Recently, histopathological tumour regression, prevalence of signet ring cells, and localisation were reported as prognostic factors in neoadjuvantly treated oesophagogastric (junctional and gastric) cancer. This exploratory retrospective study analyses independent prognostic factors within a large patient cohort after preoperative chemotherapy including clinical and histopathological factors.Methods:In all, 850 patients presenting with oesophagogastric cancer staged cT3/4 Nany cM0/x were treated with neoadjuvant chemotherapy followed by resection in two academic centres. Patient data were documented in a prospective database and retrospectively analysed.Results:Of all factors prognostic on univariate analysis, only clinical response, complications, ypTNM stage, and R category were independently prognostic (P<0.01) on multivariate analysis. Tumour localisation and signet ring cells were independently prognostic only when investigator-dependent clinical response evaluation was excluded from the multivariate model. Histopathological tumour regression correlates with tumour grading, Laurén classification, clinical response, ypT, ypN, and R categories but was not identified as an independent prognostic factor. Within R0-resected patients only surgical complications and ypTNM stage were independent prognostic factors.Conclusions:Only established prognostic factors like ypTNM stage, R category, and complications were identified as independent prognostic factors in resected patients after neoadjuvant chemotherapy. In contrast, histopathological tumour regression was not found as an independent prognostic marker.

Tumor response evaluation after neoadjuvant chemotherapy in locally advanced gastric adenocarcinoma: a prospective, multi-center cohort study

“…Regarding histopathological response (Becker's criteria), our series shows 29% of patients with total or sub-total response (TRG1), and these data are consistent with those obtained in the two main retrospective studies concerning TRG (21% and 24% of TRG1 in Becker's and in Schmidt's study, respectively) (12,16). Differently, in two recent retrospective works regarding predictor factors of survival after perioperative MAGIC-style chemotherapy, TRG1 rates were lower (17%) (17,18).…”

“…We found better results in terms of both DSF and OS in patients with a good radiological response to chemotherapy assessed by CT, as we reported above (Figures 1,2) ( Table 4). The prognostic value of radiological response has been already described in previous studies (5,12,13), however its significance in patients with gastric cancer must be valued with considerable caution. Indeed, chemotherapy-induced inflammation and edema can distort the layers of the stomach wall and can lead to errors in evaluating the depth of tumor invasion (14).…”

Surgical strategies in true adenocarcinoma of the esophagogastric junction (AEG II): thoracoabdominal or abdominal approach?

“…Tumors of patients having been treated before 2010 were reclassified according to the new TNM classification. Histopathological response was graded according to Becker et al [30][31][32].…”

High Impact of Histopathological Remission for Prognosis after Perioperative Chemotherapy with ECF and ECF-Like Regimens for Gastric and Gastroesophageal Adenocarcinoma

“…Furthermore, the effect of a positive prognostic value of histopathological remission on survival has already been shown in several retrospective trials [7,9,10,11,12,13,14,15]. In these studies, the pathological complete response (pCR) rate ranged between 1.1 and 11.1%.…”

“…Analyzing prognostic factors in patients treated perioperatively with a variety of chemotherapeutic regimens, most studies could identify the pyT, pyN, vascular invasion, Lauren classification, signet ring cell status, tumor localization and differentiation to be associated with OS [7,8,9,10,11,12,13,14,15]. …”