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. 2024 Jan 31;111(2):znae034.
doi: 10.1093/bjs/znae034.

Prognostic value of Mandard score and nodal status for recurrence patterns and survival after multimodal treatment of oesophageal adenocarcinoma

Sofie P G Henckens  1   2   3 , Dajia Liu  4   5 , Suzanne S Gisbertz  1   2   3 , Marianne C Kalff  1   2   3 , Maarten C J Anderegg  1   2   3 , David Crull  6 , Freek Daams  7 , Annette D van Dalsen  8 , Jan Willem T Dekker  9 , Marc J van Det  6 , Peter van Duijvendijk  10 , Wietse J Eshuis  1   2   3 , Richard P R Groenendijk  11 , Jan Willem Haveman  12 , Richard van Hillegersberg  13 , Misha D P Luyer  14 , Pim B Olthof  9 , Jean-Pierre E N Pierie  15 , Victor D Plat  7 , Camiel Rosman  16 , Jelle P Ruurda  13 , Johanna W van Sandick  17 , Meindert N Sosef  18 , Daan M Voeten  1   2   3 , Guy H E J Vijgen  19 , Maarten F Bijlsma  2   5   20 , Sybren L Meijer  2   21 , Maarten C C M Hulshof  2   22 , Cesar Oyarce  5   20 , Sjoerd M Lagarde  19 , Hanneke W M van Laarhoven  2   4 , Mark I van Berge Henegouwen  1   2   3 ; IVORY study group
Collaborators, Affiliations

Prognostic value of Mandard score and nodal status for recurrence patterns and survival after multimodal treatment of oesophageal adenocarcinoma

Sofie P G Henckens et al. Br J Surg. .

Abstract

Background: This study evaluated the association of pathological tumour response (tumour regression grade, TRG) and a novel scoring system, combining both TRG and nodal status (TRG-ypN score; TRG1-ypN0, TRG>1-ypN0, TRG1-ypN+ and TRG>1-ypN+), with recurrence patterns and survival after multimodal treatment of oesophageal adenocarcinoma.

Methods: This Dutch nationwide cohort study included patients treated with neoadjuvant chemoradiotherapy followed by oesophagectomy for distal oesophageal or gastro-oesophageal junctional adenocarcinoma between 2007 and 2016. The primary endpoint was the association of Mandard score and TRG-ypN score with recurrence patterns (rate, location, and time to recurrence). The secondary endpoint was overall survival.

Results: Among 2746 inclusions, recurrence rates increased with higher Mandard scores (TRG1 30.6%, TRG2 44.9%, TRG3 52.9%, TRG4 61.4%, TRG5 58.2%; P < 0.001). Among patients with recurrent disease, the distribution (locoregional versus distant) was the same for the different TRG groups. Patients with TRG1 developed more brain recurrences (17.7 versus 9.8%; P = 0.001) and had a longer mean overall survival (44 versus 35 months; P < 0.001) than those with TRG>1. The TRG>1-ypN+ group had the highest recurrence rate (64.9%) and worst overall survival (mean 27 months). Compared with the TRG>1-ypN0 group, patients with TRG1-ypN+ had a higher risk of recurrence (51.9 versus 39.6%; P < 0.001) and worse mean overall survival (33 versus 41 months; P < 0.001).

Conclusion: Improved tumour response to neoadjuvant therapy was associated with lower recurrence rates and higher overall survival rates. Among patients with recurrent disease, TRG1 was associated with a higher incidence of brain recurrence than TRG>1. Residual nodal disease influenced prognosis more negatively than residual disease at the primary tumour site.

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Figures

Fig. 1
Fig. 1
Study flow chart
Fig. 2
Fig. 2
Recurrence patterns, stratified by Mandard score
Fig. 3
Fig. 3
Specific locations of recurrent disease
Fig. 4
Fig. 4
Time to recurrence and survival curves, stratified by Mandard score
Fig. 5
Fig. 5
Recurrence patterns, stratified by TRG-ypN score
Fig. 6
Fig. 6
Impact of TRG-ypN score on patterns of recurrence and survival
See this image and copyright information in PMC

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Supplementary concepts