Does a high Mandard score really define a poor response to chemotherapy in oesophageal adenocarcinoma?
| Autor: | Cara R. Baker, William R. C. Knight, Wahyu Wulaningsih, Andrew Davies, Mark Kelly, Nyree Griffin, James A. Gossage |
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| Rok vydání: | 2021 |
| Předmět: |
Adult
Male Cancer Research medicine.medical_specialty Time Factors Esophageal Neoplasms medicine.medical_treatment Improved survival Oesophageal adenocarcinoma Adenocarcinoma Gastroenterology Biomarkers Pharmacological Article Cohort Studies 03 medical and health sciences 0302 clinical medicine Internal medicine Antineoplastic Combined Chemotherapy Protocols Humans Medicine In patient Neoplasm Staging Chemotherapy business.industry Proportional hazards model Hazard ratio Significant difference Prognosis Survival Analysis Neoadjuvant Therapy United Kingdom Esophagectomy Treatment Outcome Oncology Research Design 030220 oncology & carcinogenesis Female Circumferential resection margin Neoplasm Grading business Follow-Up Studies |
| Zdroj: | Br J Cancer |
| ISSN: | 1532-1827 0007-0920 |
| Popis: | Background A high Mandard score implies a non-response to chemotherapy in oesophageal adenocarcinoma. However, some patients exhibit tumour volume reduction and a nodal response despite a high score. This study examines survival and recurrence patterns in these patients. Methods Clinicopathological factors were analysed using multivariable Cox regression assessing time to death and recurrence. Computed tomography-estimated tumour volume change was examined in a subgroup of consecutive patients. Results Five hundred and fifty-five patients were included. Median survival was 55 months (Mandard 1-3) and 21 months (Mandard 4 and 5). In the Mandard 4 and 5 group (332 patients), comparison between complete nodal responders and persistent nodal disease showed improved survival (90 vs 18 months), recurrence rates (locoregional 14.75 vs 28.74%, systemic 24.59 vs 48.42%) and circumferential resection margin positivity (22.95 vs 68.11%). Complete nodal response independently predicted improved survival (hazard ratio 0.34 (0.16-0.74). Post-chemotherapy tumour volume reduction was greater in patients with a complete nodal response (-16.3 vs -7.7 cm3, p = 0.033) with no significant difference between Mandard groups. Conclusion Patients with a complete nodal response to chemotherapy have significantly improved outcomes despite a poor Mandard score. High Mandard score does not correspond with a non-response to chemotherapy in all cases and patients with nodal downstaging may still benefit from adjuvant chemotherapy. |
| Databáze: | OpenAIRE |
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