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A Multifactorial Histopathologic Score for the Prediction of Prognosis of Resected Esophageal Adenocarcinomas After Neoadjuvant Chemotherapy

Langer, Rupert ; Becker, Karen ; Zlobec, Inti ; Gertler, Ralf ; Sisic, Leila ; Büchler, Markus ; Lordick, Florian ; Slotta-Huspenina, Julia ; Weichert, Wilko ; Höfler, Heinz ; Feith, Marcus ; Ott, Katja

In: Annals of Surgical Oncology, 2014, vol. 21, no. 3, p. 915-921

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    Titre
    • A Multifactorial Histopathologic Score for the Prediction of Prognosis of Resected Esophageal Adenocarcinomas After Neoadjuvant Chemotherapy
    Auteur
    • Langer, Rupert. Institute of Pathology, University of Bern, Bern, Switzerland
    • Becker, Karen. Institute of Pathology, Technische Universität München, Munich, Germany
    • Zlobec, Inti. Institute of Pathology, University of Bern, Bern, Switzerland
    • Gertler, Ralf. Department of Surgery, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
    • Sisic, Leila. Department of Surgery, University of Heidelberg, Heidelberg, Germany
    • Büchler, Markus. Department of Surgery, University of Heidelberg, Heidelberg, Germany
    • Lordick, Florian. University Cancer Center (UCCL) at the University Clinic Leipzig, University of Leipzig, Leipzig, Germany
    • Slotta-Huspenina, Julia. Institute of Pathology, Technische Universität München, Munich, Germany
    • Weichert, Wilko. Institute of Pathology, University of Heidelberg, Heidelberg, Germany
    • Höfler, Heinz. Institute of Pathology, Technische Universität München, Munich, Germany
    • Feith, Marcus. Department of Surgery, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
    • Ott, Katja. Department of Surgery, University of Heidelberg, Heidelberg, Germany
    Type de document
    • Postprint
    Langue
    • Anglais
    Publié dans
    • Annals of Surgical Oncology, 2014, vol. 21, no. 3, p. 915-921. Springer US; http://www.springer-ny.com
    Autre version électronique
    Classification
    • Santé
    Identifiant OAI-PMH
    • oai:doc.rero.ch:325412
    Summary
    Background: For esophageal adenocarcinoma treated with neoadjuvant chemotherapy, postoperative staging classifications initially developed for non-pretreated tumors may not accurately predict prognosis. We tested whether a multifactorial TNM-based histopathologic prognostic score (PRSC), which additionally applies to tumor regression, may improve estimation of prognosis compared with the current Union for International Cancer Control/American Joint Committee on Cancer (UICC) staging system. Patients and Methods: We evaluated esophageal adenocarcinoma specimens following cis/oxaliplatin-based therapy from two separate centers (center 1: n=280; and center 2: n=80). For the PRSC, each factor was assigned a value from 1 to 2 (ypT0-2=1 point; ypT3-4=2 points; ypN0=1 point; ypN1-3=2 points; ≤50% residual tumor/tumor bed=1 point; >50% residual tumor/tumor bed=2 points). The three-tiered PRSC was based on the sum value of these factors (group A: 3; group B: 4-5; group C: 6) and was correlated with patients' overall survival (OS). Results: The PRSC groups showed significant differences with respect to OS (p<0.0001; hazard ratio [HR] 2.2 [95% CI 1.7-2.8]), which could also be demonstrated in both cohorts separately (center 1 p<0.0001; HR 2.48 [95% CI 1.8-3.3] and center 2 p=0.015; HR 1.7 [95% CI 1.1-2.6]). Moreover, the PRSC showed a more accurate prognostic discrimination than the current UICC staging system (p<0.0001; HR 1.15 [95% CI 1.1-1.2]), and assessment of two goodness-of-fit criteria (Akaike Information Criterion and Schwarz Bayesian Information Criterion) clearly supported the superiority of PRSC over the UICCstaging. Conclusion: The proposed PRSC clearly identifies three subgroups with different outcomes and may be more helpful for guiding further therapeutic decisions than the UICC staging system.