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


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2013-11-27

AUTHORS

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

ABSTRACT

BackgroundFor 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 MethodsWe 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).ResultsThe 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.ConclusionThe proposed PRSC clearly identifies three subgroups with different outcomes and may be more helpful for guiding further therapeutic decisions than the UICC staging system. More... »

PAGES

915-921

Identifiers

URI

http://scigraph.springernature.com/pub.10.1245/s10434-013-3410-y

DOI

http://dx.doi.org/10.1245/s10434-013-3410-y

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1011950414

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/24281419


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32 schema:description BackgroundFor 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 MethodsWe 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).ResultsThe 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.ConclusionThe proposed PRSC clearly identifies three subgroups with different outcomes and may be more helpful for guiding further therapeutic decisions than the UICC staging system.
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39 schema:keywords American Joint Committee
40 BackgroundFor esophageal adenocarcinoma
41 Cancer (AJCC) staging system
42 Cancer Control/American Joint Committee
43 Committee
44 ConclusionThe
45 Control/American Joint Committee
46 International Cancer Control/American Joint Committee
47 Joint Committee
48 MethodsWe
49 Multifactorial Histopathologic Score
50 PRSC groups
51 TNM
52 UICC
53 UICC staging system
54 Union
55 accurate prognostic discrimination
56 adenocarcinoma
57 assessment
58 center
59 chemotherapy
60 cis/oxaliplatin-based therapy
61 classification
62 cohort
63 criteria
64 current UICC staging system
65 current union
66 decisions
67 differences
68 different outcomes
69 discrimination
70 esophageal adenocarcinoma
71 estimation
72 estimation of prognosis
73 factors
74 fit criteria
75 further therapeutic decisions
76 goodness
77 group
78 histopathologic prognostic score
79 histopathologic scores
80 multifactorial TNM
81 neoadjuvant chemotherapy
82 non-pretreated tumors
83 outcomes
84 overall survival
85 oxaliplatin-based therapy
86 patients
87 patients' overall survival
88 postoperative staging classifications
89 prediction
90 prediction of prognosis
91 prognosis
92 prognostic discrimination
93 prognostic score
94 regression
95 resected esophageal adenocarcinoma
96 respect
97 scores
98 separate centers
99 significant differences
100 staging classification
101 staging system
102 subgroups
103 sum values
104 superiority
105 superiority of PRSC
106 survival
107 system
108 therapeutic decisions
109 therapy
110 three-tiered PRSC
111 tumors
112 values
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