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. 2021 May;124(10):1653-1660.
doi: 10.1038/s41416-021-01290-4. Epub 2021 Mar 19.

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

William R C Knight  1 , Cara R Baker  1 , Nyree Griffin  2 , Wahyu Wulaningsih  3 , Mark Kelly  1 , Andrew R Davies  1   3   4 , James A Gossage  5   6   7 ; Guy’s & St Thomas’ Oesophago-Gastric Research Group
Collaborators, Affiliations

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

William R C Knight et al. Br J Cancer. 2021 May.

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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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1. Kaplan-Meier survival analysis of each nodal response group by Mandard category.
Mandard 4 and 5 above and Mandard 1–3 below.
Fig. 2
Fig. 2. Kaplan-Meier recurrence free survival anlysis.
(a) Locoregional disease free survival in Mandard 4 and 5 patients by nodal group. (b) Locoregional disease free survival in Mandard 1, 2, 3 patients by nodal group. (c) Systemic disease free survival in Mandard 4 and 5 patients by nodal group. (d) Systemic disease free survival in Mandard 1, 2, 3 patients by nodal group.
See this image and copyright information in PMC

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