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Clinical Studies

Combined regression score predicts outcome after neoadjuvant treatment of oesophageal cancer

British Journal of Cancer volume 128, pages 2025–2035 (2023)Cite this article

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Abstract

Background

Histopathologic regression following neoadjuvant treatment (NT) of oesophageal cancer is a prognostic factor of survival, but the nodal status is not considered. Here, a score combining both to improve prediction of survival after neoadjuvant therapy is developed.

Methods

Seven hundred and fifteen patients with oesophageal squamous cell (SCC) or adenocarcinoma (AC) undergoing NT and esophagectomy were analysed. Histopathologic response was classified according to percentage of vital residual tumour cells (VRTC): complete response (CR) without VRTC, major response with <10% VRTC, minor response with >10% VRTC. Nodal stage was classified as ypN0 and ypN+. Kaplan–Meier and Cox regression were used for survival analysis.

Results

Survival analysis identified three groups with significantly different mortality risks: (1) low-risk group for CR (ypT0N0) with 72% 5-year overall survival (5y-OS), (2) intermediate-risk group for minor/major responders and ypN0 with 59% 5y-OS, and (3) high-risk group for minor/major responders and ypN+ with 20% 5y-OS (p < 0.001). Median survival in AC and SCC cohorts were comparable (3.8 (CI 95%: 3.1, 5.3) vs. 4.6 years (CI 95%: 3.3, not reached), p = 0.3).

Conclusions

Histopathologic regression and nodal status should be combined for estimating AC and SCC prognosis. Poor survival in the high-risk group highlights need for adjuvant therapy.

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Fig. 1: Flow chart of patient selection.
Fig. 2: Overall survival of AC patients after CROSS and FLOT and SCC patients after CROSS.
Fig. 3: Overall survival stratified by nodal status in AC and SCC after CROSS or FLOT neoadjuvant therapy.
Fig. 4: Overall survival stratified by UICC and complete response in the AC and SCC cohort after CROSS and FLOT.
Fig. 5: Overall survival stratified by local tumour response and nodal status into four groups.
Fig. 6: Overall survival according to proposed risk score.

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Data availability

Data are available on request to the corresponding author due to privacy/ethical restrictions.

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Funding

No funding was obtained for this study.

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Authors and Affiliations

  1. Department of General, Visceral, Cancer and Transplantation Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany

    A. I. Damanakis, A. Stapper, H. A. Schlößer, T. Schmidt, L. M. Schiffmann, H. Fuchs, C. J. Bruns & W. Schroeder

  2. Department of General and Visceral Surgery, Helios University Hospital of Wuppertal, Wuppertal, Germany

    F. Gebauer

  3. Center for Molecular Medicine Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany

    H. A. Schlößer

  4. Department of General Visceral and Endocrine Surgery, Stadt Soest Hospital, Soest, Germany

    M. Ghadimi

  5. Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Gastrointestinal Cancer Group Cologne GCGC Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany

    T. Zander

  6. Institute of Pathology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany

    A. Quaas

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Contributions

AID: conceptualisation, methodology, formal analysis, investigation, writing—original draft, visualisation, data curation, revisions, point-by-point response. FG: conceptualisation, investigation, resources, data curation, writing—review and editing, validation. AS: investigation, data curation, methodology. HS: conceptualisation, writing—review and editing. MG: investigation, data curation. HF: resources, data curation, writing—review and editing. TZ: investigation, conceptualisation, writing—review and editing. TS: writing—review and editing. LS: writing—review and editing. AQ: conceptualisation, data curation, methodology, writing—original draft, supervision, validation. CB: resources, supervision, writing—review and editing, revisions. WS: project administration, supervision, data curation, investigation, methodology, writing—original draft, validation, revisions, point-by-point response.

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Correspondence to W. Schroeder.

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Damanakis, A.I., Gebauer, F., Stapper, A. et al. Combined regression score predicts outcome after neoadjuvant treatment of oesophageal cancer. Br J Cancer 128, 2025–2035 (2023). https://doi.org/10.1038/s41416-023-02232-y

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