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  • 1
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    PS02.064: ACCURACY OF F-18-FDG-PET/CT IN MONITORING TUMOUR RESPONSE AFTER NEOADJUVANT CHEMORADIOTHERAPY IN PATIENTS WITH OESOPHAGEAL CANCER
    Oxford University Press (OUP) ; 2018
    In:  Diseases of the Esophagus Vol. 31, No. Supplement_1 ( 2018-09-01), p. 138-139
    Details
    In: Diseases of the Esophagus, Oxford University Press (OUP), Vol. 31, No. Supplement_1 ( 2018-09-01), p. 138-139
    Abstract: Neoadjuvant chemoradiotherapy (nCRT) induces a pathologically complete response in approximately 30% of patients with oesophageal cancer. To explore the possibility of safe postponement of surgery, accurate clinical response evaluations are needed to exclude residual disease. The present study aims to assess the value of F-18-FDG-PET/CT for the detection of residual tumour ( 〉  10% tumour cells = TRG3–4 vs. no vital cells = TRG1) or metastases after nCRT. Methods FDG-PET/CT at baseline and 12 weeks after nCRT was performed according to the European Association of Nuclear Medicine guidelines 1.0 (2.3MBq/kg F-18-FDG; scanning 60 ± 5min.) and the protocol of the preSANO study. Qualitative analysis included sensitive reading of presence of residual tumour and/or metastases. A lesion was considered FDG-positive, when any uptake in the lesion itself was above the adjacent oesophageal background uptake. Quantitatively, SUV/lean body mass (SUL) measurements at tumour, lymph nodes, oesophagus, liver and bloodpool were recorded and compared with pathology (resection specimen: gold standard). Results Some 129 of 207 patients with FDG-avid tumours at baseline proceeded to FDG-PET/CT at around 12 weeks after nCRT just before surgery. Forty-one of 129 patients had TRG3–4, of whom 6 were missed on FDG-PET/CT (15% false negative) with SULmax 2.07 ± 0.25, SUL-ratio tumour/oesophagus (SULR) 1.35 ± 0.14. Sensitivity for TRG2–3-4 vs. TRG1 was 57/71 (80%). SULmax and SULR of FDG-positives were 3.76 ± 1.33 and 1.82 ± 0.69 respectively, compared to SULmax 2.21 ± 0.42 and SULR 1.31 ± 0.22 in FDG-negatives. Distant metastases were detected in 18 of 190 (10%) patients. Of all patients with postponed surgery, 12 had ≥ 1 additional FDG-PET/CT during follow-up (25–49.7 weeks after nCRT). Eventually, 4 patients underwent surgery. Three of 4 had increased FDG-signal and TRG3–4; 1 patient had decreased FDG-signal and no tumour left (TRG1). Conclusion FDG-PET/CT at around 12 weeks after nCRT misses TRG3–4 tumours in 15% and detects residual TRG2–3-4 in 80%. Furthermore, PET-CT detects distant metastases in 10% of patients after nCRT. These data indicate that serial FDG-PET may become valuable in an active surveillance approach. Disclosure All authors have declared no conflicts of interest.
    Type of Medium: Online Resource
    ISSN: 1120-8694 , 1442-2050
    URL: Article
    DOI: 10.1093/dote/doy089.PS02.064
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2018
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  • 2
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    796 OUTCOMES OF DELAYED SURGERY IN PATIENTS WITH RESIDUAL DISEASE AFTER NEOADJUVANT CHEMORADIOTHERAPY FOR OESOPHAGEAL CANCER
    Oxford University Press (OUP) ; 2021
    In:  Diseases of the Esophagus Vol. 34, No. Supplement_1 ( 2021-09-17)
    Details
    In: Diseases of the Esophagus, Oxford University Press (OUP), Vol. 34, No. Supplement_1 ( 2021-09-17)
    Abstract: Standard treatment for locally advanced oesophageal cancer is neoadjuvant chemoradiotherapy (nCRT), plus surgery 6-8 weeks later. Time to surgery (TTS) after nCRT seems safe up to 12 weeks, and possibly improves patient condition and pathological response. However, it is unknown whether prolonged TTS is safe in patients with residual disease. The aim of this study was to investigate whether prolonged TTS leads to inferior surgical outcomes and survival in patients with residual disease after nCRT. Methods Patients with pathologically confirmed residual disease 4-6 weeks after nCRT who underwent preoperative PET/CT and surgery were selected from the preSANO-trial and SANO-trial. Patients were stratified by TTS ≤12 weeks versus TTS & gt;12 weeks after completion of nCRT. Primary endpoint was overall survival (OS). Secondary endpoints were progression-free survival (PFS), peroperative unresectability, microscopically radical resections (R0), tumour regression grade (TRG), postoperative complications and risk of distant dissemination. Effects of TTS on OS, PFS and distant dissemination were analysed with Cox regression, adjusted for Charlson comorbidity index (CCI) at baseline, as well as WHO performance score and weight loss after nCRT. Results Forty-two patients were included in the TTS & gt;12 weeks and 132 patients in the TTS ≤12 weeks group. Median follow-up was 20.6 months (IQR 16.1-30.3). Adjusted hazard ratios for OS and PFS were 0.50 (95% CI: 0.24-1.02) and 0.47 (95% CI: 0.25-0.91), respectively, in favour of TTS & gt;12 weeks. Patients with TTS & gt;12 weeks had more postoperative complications (89% vs 72%, p = 0.049), but comparable peroperatively unresectable tumours (11.9% vs. 3.8%, p = 0.11), R0-resections (89% vs 87%, p = 0.89), and TRG-scores (p = 0.97) compared to patients with TTS ≤12 weeks. Patients with TTS & gt;12 weeks showed less distant dissemination (HR 0.40, 95% CI: 0.18-0.88). Conclusion Prolonged TTS beyond 12 weeks in patients with clinically proven residual disease after nCRT did not have a negative effect on OS and on PFS, but was correlated with an increase in postoperative complications. The (non-significantly) better survival outcomes for TTS & gt;12 weeks may be explained by the fact that patients had a lower risk of developing distant dissemination, which may reflect improved selection prior to surgery.
    Type of Medium: Online Resource
    ISSN: 1120-8694 , 1442-2050
    URL: Article
    DOI: 10.1093/dote/doab052.796
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2021
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  • 3
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    453. TREATMENT AND SURVIVAL OF PATIENTS WITH A POSITIVE RESECTION MARGIN AFTER NEOADJUVANT CHEMORADIOTHERAPY AND ESOPHAGECTOMY
    Oxford University Press (OUP) ; 2023
    In:  Diseases of the Esophagus Vol. 36, No. Supplement_2 ( 2023-08-30)
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    In: Diseases of the Esophagus, Oxford University Press (OUP), Vol. 36, No. Supplement_2 ( 2023-08-30)
    Abstract: Esophagectomy after neoadjuvant chemoradiotherapy (nCRT) is associated with a tumor-positive resection margin in 4–9% of patients. Although survival in patients with a positive margin is decreased, Western guidelines do not recommend adjuvant systemic/local treatment after esophagectomy. The aim of this study was to assess whether patients underwent adjuvant therapy, regardless the lack of evidence from guidelines, and to evaluate the overall survival (OS) in patients that underwent esophagectomy and had a positive resection margin. Methods All patients diagnosed with resectable (cT2-4a/cTxN0–3/NxM0) esophageal or junctional cancer that underwent nCRT followed by esophagectomy between 2015 and 2021 were selected from the Netherlands’ Cancer Registry. Included were patients with a tumor-positive resection margin. The primary endpoint was the proportion of patients that started adjuvant treatment ≤16 weeks after esophagectomy, including chemotherapy, radiotherapy, immunotherapy or targeted therapy. Secondary outcome OS was calculated from date of surgery until date of death or last day of follow-up, using the Kaplan Meier method. Results Among the 300 included patients, 98.7% had a microscopically irradical resection (R1), while 1.3% had a macroscopically irradical resection (R2). The median age was 67 (interquartile range 60–72) years and WHO 0–1 (89.3%). Esophagectomy was performed open (8.3%), laparoscopically (57.7%) or robot-assisted (33%) and via transthoracic (89.7%) or transhiatal approach (8.7%). Some 71% of tumors had a partial response (Mandard category 1–3) or no pathological response (Mandard 4–5; 12.7%) to nCRT. One patient underwent external radiotherapy after esophagectomy. Twenty patients (7%) underwent adjuvant immunotherapy (nivolumab), despite their irradical resection. Median OS of all patients was 18.6 months (95% CI 14.7–22.4). Conclusion Real-world population level data showed that 7% of patients were treated with adjuvant immunotherapy, despite lack of evidence of the benefit thereof in patients with an irradical resection. This underlines the need for better neoadjuvant therapy leading to less irradical resections, as well as prospective studies evaluating adjuvant therapy in patients with an irradical resection.
    Type of Medium: Online Resource
    ISSN: 1120-8694 , 1442-2050
    URL: Article
    DOI: 10.1093/dote/doad052.240
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2023
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  • 4
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    270. PERIOPERATIVE CHEMOTHERAPY FOR OPERABLE GASTRO-ESOPHAGEAL JUNCTION OR GASTRIC CANCER: FLOT VERSUS ANTHRACYCLINE TRIPLETS
    Oxford University Press (OUP) ; 2023
    In:  Diseases of the Esophagus Vol. 36, No. Supplement_2 ( 2023-08-30)
    Details
    In: Diseases of the Esophagus, Oxford University Press (OUP), Vol. 36, No. Supplement_2 ( 2023-08-30)
    Abstract: Since the FLOT4-AIO study (2019) showed improved survival in patients treated with neoadjuvant fluorouracil, leucovorin, oxaliplatin and docetaxel (FLOT) compared to those treated with neoadjuvant anthracycline triplets, FLOT became standard of care in the Netherlands and most Western countries. The aim of this study was to compare the overall survival (OS), pathological response and surgical outcomes of FLOT chemotherapy to anthracycline triplets in the Netherlands, using real-world population level data. Methods Patients diagnosed with resectable (cT2-4a/cTxN0–3/NxM0) gastro-esophageal junction and gastric carcinoma between 2015–2020 were selected from the Netherlands’ Cancer Registry. Patients were included if they received neoadjuvant FLOT or anthracycline triplets whether this was followed by resection or not. OS was calculated from start of neoadjuvant therapy, analyzed using cox regression analysis and adjusted for sex, age, comorbidities, performance status, cT-stage/cN-stage and tumor grade. Secondary outcomes included the pathological complete response (pCR), proportion of patients that fully completed neoadjuvant chemotherapy (100% of scheduled cycles permitting dose reductions), proportion of patients that underwent (radical) surgical resection and proportion receiving adjuvant therapy. Results 778 included patients were treated with FLOT and 913 with anthracycline triplets. Patients treated with FLOT underwent more staging diagnostic laparoscopies (DLS) (73.5% vs. 44.1%, p  & lt; 0.0001). Adjusted OS was better after neoadjuvant FLOT (HR = 0.84, 95% CI 0.72–0.98, p = 0.03). 3-year and 5-year OS were 56.4% and 46.6% after FLOT and 52.7% and 45.5% after anthracycline triplets, respectively. A higher proportion of patients treated with FLOT fully completed neoadjuvant chemotherapy (78.5% vs. 73.1%, p = 0.009) and had R0 resections (86.2% vs. 85.2%, p = 0.007). No statistically significant differences were seen in the proportions of patients that underwent resection, received adjuvant therapy, or had pCR. Conclusion Real-world population level data showed better OS of patients treated with FLOT chemotherapy compared to anthracycline triplets. No statistically significant difference was observed in pCR or resection rates. Thus, not every outcome as described in the FLOT4-AIO trial could be reproduced in a real-world population, despite improved staging with DLS in the FLOT group. Divergent baseline characteristics and less intensive neoadjuvant treatments in real-world patients compared to patients in clinical trials may contribute to this discrepancy.
    Type of Medium: Online Resource
    ISSN: 1120-8694 , 1442-2050
    URL: Article
    DOI: 10.1093/dote/doad052.109
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2023
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  • 5
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    Pathological response to neoadjuvant chemoradiotherapy for oesophageal squamous cell carcinoma: multicentre East Asian and Dutch database comparison
    Oxford University Press (OUP) ; 2022
    In:  British Journal of Surgery Vol. 109, No. 12 ( 2022-11-22), p. 1312-1318
    Details
    In: British Journal of Surgery, Oxford University Press (OUP), Vol. 109, No. 12 ( 2022-11-22), p. 1312-1318
    Abstract: Patients with different ethnic and genetic backgrounds may respond differently to anticancer therapies. This study aimed to assess whether patients with oesophageal squamous cell carcinoma (OSCC) treated with neoadjuvant chemoradiotherapy (nCRT) in East Asia had an inferior pathological response compared with patients treated in Northwest Europe. Methods Patients with OSCC who underwent nCRT according to the CROSS regimen (carboplatin and paclitaxel with concurrent 41.4 Gy radiotherapy) followed by oesophagectomy between June 2012 and April 2020 were identified from East Asian and Dutch databases. The primary outcome was pCR, defined as ypT0 N0. Groups were compared using propensity score matching, adjusting for sex, Charlson Co-morbidity Index score, tumour location, cT and cN categories, interval between nCRT and surgery, and number of resected lymph nodes. Results Of 725 patients identified, 133 remained in each group after matching. A pCR was achieved in 37 patients (27.8 per cent) in the Asian database and 58 (43.6 per cent) in the Dutch database (P = 0.010). The rate of ypT1–4 was higher in Asian than Dutch data (66.2 and 49.6 per cent; P = 0.004). The ypN1–3 rate was 44.4 per cent in the Asian and 33.1 per cent in the Dutch data set. Clear margins were achieved in 92.5 per cent of Asian and 95.5 per cent of Dutch patients. Conclusion Regional differences in responses to CROSS nCRT for oesophageal cancer were apparent, the origin of which will need evaluation.
    Type of Medium: Online Resource
    ISSN: 0007-1323 , 1365-2168
    URL: Article
    DOI: 10.1093/bjs/znac314
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2022
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  • 6
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    681 PATTERN OF RECURRENCE IN PATIENTS WITH A PATHOLOGICALLY COMPLETE RESPONSE AFTER NEOADJUVANT CHEMORADIOTHERAPY AND SURGERY FOR OESOPHAGEAL CANCER
    Oxford University Press (OUP) ; 2021
    In:  Diseases of the Esophagus Vol. 34, No. Supplement_1 ( 2021-09-17)
    Details
    In: Diseases of the Esophagus, Oxford University Press (OUP), Vol. 34, No. Supplement_1 ( 2021-09-17)
    Abstract: Neoadjuvant chemoradiotherapy (nCRT) and surgery is a widely used treatment for locally advanced resectable oesophageal cancer, with 20 and 50% of patients having a pathological complete response (pCR). Disease, however, still recurs in 20–30% of these patients. The aim of this study was to assess the pattern of recurrence in patients with pCR after nCRT and surgery. Methods All patients with pCR after neoadjuvant chemoradiotherapy and surgery included in the phase II and III ChemoRadiotherapy for Oesophageal followed by Surgery Study (CROSS) trials (April 2001—March 2009) and after the CROSS trials (September 2009—October 2017) were identified. The site of recurrence was compared to the applied radiation and surgical fields. Outcomes were median time to recurrence, overall and progression-free survivals. Results A total of 141 patients with a median follow-up of 100 (interquartile range [IQR] 64–134) months were included. Some 29 of 141 patients (21%) developed recurrence. Of these, four (14%) had isolated locoregional recurrence, 15 (52%) distant recurrence only and ten (34%) had both locoregional and distant recurrence. Among the 14 patients with locoregional recurrences, five were within the radiation field, seven outside the radiation field and two at the border. Median (IQR) time to recurrence was 24 (10–62) months. The 5-year overall survival was 74% and recurrence-free survival 70%. Conclusion Despite good overall survival, recurrence still occurred in 21% of patients. Most recurrences were distant, outside the radiation and surgical fields.
    Type of Medium: Online Resource
    ISSN: 1120-8694 , 1442-2050
    URL: Article
    DOI: 10.1093/dote/doab052.681
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2021
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  • 7
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    Recommendations for endoscopic surveillance after esophageal atresia repair in adults
    Oxford University Press (OUP) ; 2022
    In:  Diseases of the Esophagus Vol. 35, No. 7 ( 2022-07-12)
    Details
    In: Diseases of the Esophagus, Oxford University Press (OUP), Vol. 35, No. 7 ( 2022-07-12)
    Abstract: Endoscopic surveillance of adults with esophageal atresia is advocated, but the optimal surveillance strategy remains uncertain. This study aimed to provide recommendations on appropriate starting age and intervals of endoscopic surveillance in adults with esophageal atresia. Methods Participants underwent standardized upper endoscopies with biopsies. Surveillance intervals of 3–5 years were applied, depending on age and histopathological results. Patient’s age and time to development of (pre)malignant lesions were calculated. Results A total of 271 patients with esophageal atresia (55% male; median age at baseline endoscopy 26.7 (range 15.6–68.5) years; colon interposition n = 17) were included. Barrett’s esophagus was found in 19 (7%) patients (median age 32.3 (17.8–56.0) years at diagnosis). Youngest patient with a clinically relevant Barrett’s esophagus was 20.9 years. Follow-up endoscopies were performed in 108 patients (40%; median follow-up time 4.6 years). During surveillance, four patients developed Barrett’s esophagus but no dysplasia or cancer was found. One 45-year-old woman with a colon interposition developed an adenoma with high-grade dysplasia which was radically removed. Two new cases of esophageal carcinoma were diagnosed in patients (55 and 66 years old) who were not under surveillance. One of them had been curatively treated for esophageal carcinoma 13 years ago. Conclusions This study shows that endoscopic screening of patients with esophageal atresia, including those with a colon interposition, can be started at 20 years of age. Up to the age of 40 years a surveillance interval of 10 years appeared to be safe. Endoscopic surveillance may also be warranted for patients after curative esophageal cancer treatment.
    Type of Medium: Online Resource
    ISSN: 1120-8694 , 1442-2050
    URL: Article
    DOI: 10.1093/dote/doab095
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2022
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  • 8
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    219. ASSOCIATION BETWEEN VIDEO-BASED SURGICAL PERFORMANCE AND PATIENT OUTCOMES IN MINIMALLY INVASIVE ESOPHAGECTOMY IN THE NETHERLANDS
    Oxford University Press (OUP) ; 2023
    In:  Diseases of the Esophagus Vol. 36, No. Supplement_2 ( 2023-08-30)
    Details
    In: Diseases of the Esophagus, Oxford University Press (OUP), Vol. 36, No. Supplement_2 ( 2023-08-30)
    Abstract: Increasing evidence shows substantial variation in surgical performance measured by a (video-based) competency assessment tool (CAT). Moreover, suboptimal surgical performance has been associated with less favorable patient outcomes in complex minimal invasive procedures. It is likely this also applies for minimally invasive esophagectomy (MIE). In a previous study a CAT for MIE (MIE-CAT) was developed and validated. The present study investigated the association between surgical performance and postoperative outcomes of MIE in the Netherlands. Methods A nationwide observational video analysis study was performed. All fifteen Dutch hospitals performing MIE voluntarily submitted all patient outcomes from the 2020–2021 Dutch Upper-GI Clinical Audit registry, and two representative surgical videos from 2022. Surgical performance was assessed by 7 blinded and independent expert MIE surgeons with the MIE-CAT. Hospitals were divided into quartiles based on their performance score. Multilevel logistic regression, with clustering of patients within hospitals, was used to study associations between surgical performance and patient outcomes. Primary outcome was severe postoperative complications (Clavien-Dindo ≥3) within 30 days after surgery. Results Highest- (mean MIE-CAT 113.6, SD 5.5, n = 3) versus lowest-performance-quartile (mean 94.1, SD 5.9, n = 3) had more MIE experience (Pearson’s r = 0.74, 95%CI 0.32–0.92), larger volumes (Pearson’s r = 0.46, 95%CI -0.13-0.81) and favorable outcomes (Figure 1). Performance of highest- versus lowest-quartile was statically significantly associated with less complications (severe postoperative (RR, converted from OR, = 0.50, 95%CI 0.24–0.99), peroperative (RR = 0.21, 95%CI 0.04–0.94) and any postoperative (RR = 0.54, 95%CI 0.24–0.96)), less conversions (RR = 0.21, 95%CI 0.21–0.21) and a 11.5% absolute chance reduction of severe postoperative complications for an average patient. Increased anastomotic-phase performance was associated with less anastomotic leakage (RR = 0.14, 95%CI 0.06–0.31). Conclusion This Dutch nationwide study showed statistically significant and clinically relevant associations between surgical performance and outcomes of patients undergoing MIE. An average patient has a 11.5% absolute chance reduction of a severe postoperative complication when operated in a highest-performance quartile hospital, compared to a lowest-performance quartile hospital. These findings show that good surgical performance is an essential aspect for good clinical outcomes.
    Type of Medium: Online Resource
    ISSN: 1120-8694 , 1442-2050
    URL: Article
    DOI: 10.1093/dote/doad052.072
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2023
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  • 9
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    PS01.202: MANAGEMENT OF RESECTABLE ESOPHAGEAL AND GASTRIC (MIXED ADENO)NEUROENDOCRINE CARCINOMA: A NATIONWIDE COHORT STUDY
    Oxford University Press (OUP) ; 2018
    In:  Diseases of the Esophagus Vol. 31, No. Supplement_1 ( 2018-09-01), p. 107-107
    Details
    In: Diseases of the Esophagus, Oxford University Press (OUP), Vol. 31, No. Supplement_1 ( 2018-09-01), p. 107-107
    Abstract: Esophageal and gastric neuroendocrine- and mixed adenoneuroendocrine carcinomas (NEC, MANEC) are very rare. Optimal treatment strategies, the role of surgery and outcomes remain unclear. The aim of this study is to provide insight in accuracy of diagnosing, current treatment and survival in patients with resectable esophageal and gastric (MA)NEC. Methods All patients with esophageal or gastric (MA)NEC, who underwent surgical resection between 2006–2016, were identified from the Dutch national registry for histo- and cytopathology (PALGA). Patients with a neuroendocrine tumor lower than grade 3 were excluded. Data on patients, treatment and outcomes were retrieved from the patients record. Diagnosis by endoscopic biopsy was compared with diagnosis by resection specimen. Kaplan Meier survival analysis was performed. Results A total of 49 patients were identified in 25 hospitals, including 21 patients with esophageal (MA)NEC and 26 patients with gastric (MA)NEC on resection specimen. Biopsy diagnosis of (MA)NEC was correct in 23/27 patients. However, 20/47 patients with definitive diagnosis of (MA)NEC, were misdiagnosed on biopsy. Neoadjuvant therapy was administered in 13 (62%) esophageal (MA)NECs and 12 (46%) gastric (MA)NECs. Survival curves were similar with and without neoadjuvant therapy. One (4.8%) esophageal (MA)NEC and 4 (15%) gastric (MA)NECs died within 90 days postoperatively. For esophageal (MA)NEC the median overall survival (OS) after surgery was 37 months and 1-, 3- and 5-year OS were 71%, 50% and 35%, respectively. For gastric (MA)NEC, the median OS was 23 months and 1-, 3- and 5-year OS were 62%, 50% and 39%, respectively. Conclusion Localized esophageal and gastric (MA)NEC are often misdiagnosed on endoscopic biopsies. After resection, long-term survival was achieved in respectively 35% and 39% of patients. Disclosure All authors have declared no conflicts of interest.
    Type of Medium: Online Resource
    ISSN: 1120-8694 , 1442-2050
    URL: Article
    DOI: 10.1093/dote/doy089.PS01.202
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2018
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    RA10.05: CHEMORADIOTHERAPY IMPROVES LOCO-REGIONAL CONTROL AND DISEASE-FREE SURVIVAL OVER CHEMOTHERAPY IN OESOPHAGEAL ADENOCARCINOMA WITH SIGNET RING MORPHOLOGY
    Oxford University Press (OUP) ; 2018
    In:  Diseases of the Esophagus Vol. 31, No. Supplement_1 ( 2018-09-01), p. 43-43
    Details
    In: Diseases of the Esophagus, Oxford University Press (OUP), Vol. 31, No. Supplement_1 ( 2018-09-01), p. 43-43
    Abstract: The presence of signet ring cells (SRC) is associated with poorer survival in multiple cancer types. Here we aimed to determine the predictive and prognostic value of SRC in oesophageal and junctional adenocarcinoma (OAC) for patients treated with neoadjuvant chemoradiotherapy (nCRT) or chemotherapy (nCT). Methods Patients who underwent nCRT and nCT followed by surgery for OAC between 2000 and 2016 were identified from two institutional prospective databases. Pre-treatment biopsy and surgical resection pathology reports were used to determine the presence of SRC morphology. The association between SRC histology and clinicopathological characteristics including pathological response was assessed. The prognostic impact of SRC on disease-free survival (DFS) and overall survival (OS) was determined. Survival was calculated with Kaplan Meier method and differences tested with log rank test. Results Of the 689 study patients, 129 had SRC (nCRT; n = 65, nCT; n = 64) and 560 patients had no evidence of SRC (nCRT; n = 326, nCT; n = 234). The SRC group had higher pT stage (P = 0.004) and median number of involved nodes (P = 0.004) following nCT compared with the non-SRC group. There were no significant differences between the two groups with respect to age, gender, tumour site, pN, R status or pathological complete response. For the 129 in the SRC group, nCT patients had significantly worse DFS (median [IQR]; 12 months [50–5] ) compared with nCRT patients (median [IQR]; 26 months [111–9] , P = 0.021). Moreover, nCT had a worse loco-regional recurrence-free survival (P = 0.004), but not distant recurrence-free survival (P = 0.74), in the SRC group. In contrast, there were no differences in DFS (P = 0.245) or recurrence patterns between nCRT and nCT among the 560 non-SRC patients. However, there was no significant difference in OS according to SRC status following nCT (P = 0.076) or nCRT (P = 0.541). Conclusion For SRC OAC, nCRT is associated with better DFS and loco-regional control compared with nCT. However, the presence of SRC in OAC was not prognostic for OS following nCT or nCRT. Disclosure All authors have declared no conflicts of interest.
    Type of Medium: Online Resource
    ISSN: 1120-8694 , 1442-2050
    URL: Article
    DOI: 10.1093/dote/doy089.RA10.05
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2018
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