Highlights
- •Histopathological complete/subtotal response is more frequent in intestinal-type esophagogastric adenocarcinoma (EGA).
- •The histological subtype is predictive on histopathological response.
- •Histopathological regression is a prognostic marker in EGA.
Abstract
Background
Neoadjuvant chemotherapy (neoCTx) improves survival outcomes of patients with localised
esophagogastric adenocarcinoma (EGA). This analysis evaluates the predictive value
of histopathological response after neoCTx.
Methods
A total of 461 patients with locally advanced EGA (≥T2 and/or N+) who received neoCTx
followed by surgery were analysed: 314 (68.1%) with intestinal, 94 (20.4%) with diffuse
and 53 (11.5%) with mixed histological type according to Lauren classification. Histopathological
response evaluation was available for 363 patients and performed locally. This analysis
evaluates the predictive value of histopathological subtype on histopathological response
after neoCTx. Response was correlated with survival.
Results
Median patients' age was 63 years, 79.8% were male. Tumours were localised in the
stomach in 32.5% and EG junction in 67.5% of the patients. With a median follow-up
of 49.4 months, median disease-free (DFS) and overall survival (OS) were 38.0 and
66.4 months, respectively.
Pathological complete response (TRG1a) was 8.8% and combined complete and subtotal
regression (TRG1a/b) was 27.3% for all patients. Around 9.2% of patients with intestinal
type had a TRG1a compared with 6.2% with diffuse and 10.8% with mixed type. TRG1a/b
rate was higher in intestinal (31.0%) than in diffuse (15.4%) and in mixed type (21.6%).
For patients with intestinal type, 3-year DFS was 78.4% with TRG1a and 54.3% with
other regression grades (p = 0.031). All patients with diffuse and mixed type and
TRG1a were disease free after 3 years compared with 31.1% (p = 0.056) and 47.7% (p = 0.044)
with other regression grades.
Conclusion
Histopathological subtype is predictive for histopathological response and outcome
after neoCTx, with the highest response rates in intestinal differentiated EGA.
Keywords
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Article info
Publication history
Published online: December 19, 2017
Accepted:
November 19,
2017
Received in revised form:
November 10,
2017
Received:
July 13,
2017
Identification
Copyright
© 2017 Elsevier Ltd. All rights reserved.
