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Clinical Study

Does a high Mandard score really define a poor response to chemotherapy in oesophageal adenocarcinoma?

British Journal of Cancer volume 124, pages 1653–1660 (2021)Cite this article

Subjects

Abstract

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.

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Fig. 1: Kaplan-Meier survival analysis of each nodal response group by Mandard category.
Fig. 2: Kaplan-Meier recurrence free survival anlysis.

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On behalf of the Guy’s & St Thomas’ Oesophago-Gastric Research Group

O. Hynes1, G. Tham1, C. Iezzi1, R. Bott1, N. Maisey5, A. Gaya5, S. Ngan5, A. Qureshi5, M. Green6, A. Jacques2, V. Goh7, H. Deere8, F. Chang8, U. Mahadeva8, B. Gill-Barman8, S. George8, J. Dunn9, S. Zeki9 and J. Meenan9

Author information

Authors and Affiliations

  1. Department of Surgery, Guy’s & St Thomas’ Oesophago-Gastric Centre, London, UK

    William R. C. Knight, Cara R. Baker, Mark Kelly, Andrew R. Davies, James A. Gossage, O. Hynes, G. Tham, C. Iezzi & R. Bott

  2. Department of Radiology, Guy’s and St Thomas’ Hospital, London, UK

    Nyree Griffin & A. Jacques

  3. Division of Cancer Studies, King’s College London, London, UK

    Wahyu Wulaningsih, Andrew R. Davies & James A. Gossage

  4. Unit of Gastrointestinal Research, Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden

    Andrew R. Davies & James A. Gossage

  5. Department of Oncology, Guy’s and St Thomas’ Hospital, London, UK

    N. Maisey, A. Gaya, S. Ngan & A. Qureshi

  6. Department of Pathology, Guy’s and St Thomas’Hospital, London, UK

    M. Green

  7. Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK

    V. Goh

  8. Department of Cellular Pathology, Guy’s and St Thomas’ Hospital, London, UK

    H. Deere, F. Chang, U. Mahadeva, B. Gill-Barman & S. George

  9. Department of Gastroenterology, Guy’s and St Thomas’ Hospital, London, UK

    J. Dunn, S. Zeki & J. Meenan

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  1. William R. C. Knight
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Consortia

on behalf of the Guy’s & St Thomas’ Oesophago-Gastric Research Group

  • O. Hynes
  • , G. Tham
  • , C. Iezzi
  • , R. Bott
  • , N. Maisey
  • , A. Gaya
  • , S. Ngan
  • , A. Qureshi
  • , M. Green
  • , A. Jacques
  • , V. Goh
  • , H. Deere
  • , F. Chang
  • , U. Mahadeva
  • , B. Gill-Barman
  • , S. George
  • , J. Dunn
  • , S. Zeki
  •  & J. Meenan

Contributions

Study concepts: W.R.C.K., C.R.B. and J.A.G. Study design: W.R.C.K., C.R.B., N.G., M.K., A.R.D. and J.A.G. Data acquisition: W.R.C.K., N.G. and A.R.D. Quality control of data and algorithms: W.R.C.K., W.W. and J.A.G. Data analysis and interpretation: W.R.C.K., W.W. and J.A.G. Statistical analysis: W.R.C.K., W.W. and J.A.G. Manuscript preparation: W.R.C.K. Manuscript editing: W.R.C.K., C.R.B., M.K., A.R.D. and J.A.G. Manuscript review: W.R.C.K, C.R.B., N.G., M.K., A.R.D., J.A.G. and W.W.

Corresponding author

Correspondence to James A. Gossage.

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Ethics approval for use of the database was obtained through the Integrated research application system (IRAS reference: 12-NW-0511). Appropriate consent was gained from all patients.

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Data were available on request from the authors.

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The authors declare no competing interests.

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Knight, W.R.C., Baker, C.R., Griffin, N. et al. Does a high Mandard score really define a poor response to chemotherapy in oesophageal adenocarcinoma?. Br J Cancer 124, 1653–1660 (2021). https://doi.org/10.1038/s41416-021-01290-4

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