TY - JOUR
T1 - Effect of Pathologic Tumor Response and Nodal Status on Survival in the Medical Research Council Adjuvant Gastric Infusional Chemotherapy Trial
AU - Smyth, Elizabeth C.
AU - Fassan, Matteo
AU - Cunningham, David
AU - Allum, William H.
AU - Okines, Alicia F. C.
AU - Lampis, Andrea
AU - Hahne, Jens C.
AU - Rugge, Massimo
AU - Peckitt, Clare
AU - Nankivell, Matthew
AU - Langley, Ruth
AU - Ghidini, Michele
AU - Braconi, Chiara
AU - Wotherspoon, Andrew
AU - Grabsch, Heike I.
AU - Valeri, Nicola
PY - 2016/8/10
Y1 - 2016/8/10
N2 - PurposeThe Medical Research Council Adjuvant Gastric Infusional Chemotherapy (MAGIC) trial established perioperative epirubicin, cisplatin, and fluorouracil chemotherapy as a standard of care for patients with resectable esophagogastric cancer. However, identification of patients at risk for relapse remains challenging. We evaluated whether pathologic response and lymph node status after neoadjuvant chemotherapy are prognostic in patients treated in the MAGIC trial.Materials and MethodsPathologic regression was assessed in resection specimens by two independent pathologists using the Mandard tumor regression grading system (TRG). Differences in overall survival (OS) according to TRG were assessed using the Kaplan-Meier method and compared using the log-rank test. Univariate and multivariate analyses using the Cox proportional hazards method established the relationships among TRG, clinical-pathologic variables, and OS.ResultsThree hundred thirty resection specimens were analyzed. In chemotherapy-treated patients with a TRG of 1 or 2, median OS was not reached, whereas for patients with a TRG of 3, 4, or 5, median OS was 20.47 months. On univariate analysis, high TRG and lymph node metastases were negatively related to survival (Mandard TRG 3, 4, or 5: hazard ratio [HR], 1.94; 95% CI, 1.11 to 3.39; P = .0209; lymph node metastases: HR, 3.63; 95% CI, 1.88 to 7.0; P <. 001). On multivariate analysis, only lymph node status was independently predictive of OS (HR, 3.36; 95% CI, 1.70 to 6.63; P <.001).ConclusionLymph node metastases and not pathologic response to chemotherapy was the only independent predictor of survival after chemotherapy plus resection in the MAGIC trial. Prospective evaluation of whether omitting postoperative chemotherapy and/or switching to a noncross-resistant regimen in patients with lymph node-positive disease whose tumor did not respond to preoperative epirubicin, cisplatin, and fluorouracil may be appropriate. (C) 2016 by American Society of Clinical Oncology.
AB - PurposeThe Medical Research Council Adjuvant Gastric Infusional Chemotherapy (MAGIC) trial established perioperative epirubicin, cisplatin, and fluorouracil chemotherapy as a standard of care for patients with resectable esophagogastric cancer. However, identification of patients at risk for relapse remains challenging. We evaluated whether pathologic response and lymph node status after neoadjuvant chemotherapy are prognostic in patients treated in the MAGIC trial.Materials and MethodsPathologic regression was assessed in resection specimens by two independent pathologists using the Mandard tumor regression grading system (TRG). Differences in overall survival (OS) according to TRG were assessed using the Kaplan-Meier method and compared using the log-rank test. Univariate and multivariate analyses using the Cox proportional hazards method established the relationships among TRG, clinical-pathologic variables, and OS.ResultsThree hundred thirty resection specimens were analyzed. In chemotherapy-treated patients with a TRG of 1 or 2, median OS was not reached, whereas for patients with a TRG of 3, 4, or 5, median OS was 20.47 months. On univariate analysis, high TRG and lymph node metastases were negatively related to survival (Mandard TRG 3, 4, or 5: hazard ratio [HR], 1.94; 95% CI, 1.11 to 3.39; P = .0209; lymph node metastases: HR, 3.63; 95% CI, 1.88 to 7.0; P <. 001). On multivariate analysis, only lymph node status was independently predictive of OS (HR, 3.36; 95% CI, 1.70 to 6.63; P <.001).ConclusionLymph node metastases and not pathologic response to chemotherapy was the only independent predictor of survival after chemotherapy plus resection in the MAGIC trial. Prospective evaluation of whether omitting postoperative chemotherapy and/or switching to a noncross-resistant regimen in patients with lymph node-positive disease whose tumor did not respond to preoperative epirubicin, cisplatin, and fluorouracil may be appropriate. (C) 2016 by American Society of Clinical Oncology.
KW - DISEASE-SPECIFIC SURVIVAL
KW - PREOPERATIVE CHEMORADIOTHERAPY
KW - PERIOPERATIVE CHEMOTHERAPY
KW - ESOPHAGOGASTRIC JUNCTION
KW - F-18-FDG PET
KW - CANCER
KW - REGRESSION
KW - ADENOCARCINOMA
KW - ESOPHAGEAL
KW - CARCINOMA
U2 - 10.1200/JCO.2015.65.7692
DO - 10.1200/JCO.2015.65.7692
M3 - Article
C2 - 27298411
SN - 0732-183X
VL - 34
SP - 2721
EP - 2727
JO - Journal of Clinical Oncology
JF - Journal of Clinical Oncology
IS - 23
ER -