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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 3/2014

01-03-2014 | Gastrointestinal Oncology

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

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

Published in: Annals of Surgical Oncology | Issue 3/2014

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Abstract

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 UICC staging.

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.
Appendix
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Metadata
Title
A Multifactorial Histopathologic Score for the Prediction of Prognosis of Resected Esophageal Adenocarcinomas After Neoadjuvant Chemotherapy
Authors
Rupert Langer, MD
Karen Becker, MD
Inti Zlobec, PhD
Ralf Gertler, MD
Leila Sisic, MD
Markus Büchler, MD
Florian Lordick, MD
Julia Slotta-Huspenina, MD
Wilko Weichert, MD
Heinz Höfler, MD
Marcus Feith, MD
Katja Ott, MD
Publication date
01-03-2014
Publisher
Springer US
Published in
Annals of Surgical Oncology / Issue 3/2014
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-013-3410-y

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