• Sofie P G Henckens, Dajia Liu, Suzanne S Gisbertz, Marianne C Kalff, AndereggMaarten C JMCJDepartment of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands.Cancer Centre Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands.Department of Gastroenterology and Hepatolog, David Crull, Freek Daams, Annette D van Dalsen, DekkerJan Willem TJWTDepartment of Surgery, Reinier de Graaf Groep, Delft, the Netherlands., Marc J van Det, Peter van Duijvendijk, Wietse J Eshuis, GroenendijkRichard P RRPRDepartment of Surgery, IJsselland Ziekenhuis, Capelle aan den IJssel, the Netherlands., Jan Willem Haveman, Richard van Hillegersberg, LuyerMisha D PMDP0000-0002-9483-1520Department of Surgery, Catharina Ziekenhuis, Eindhoven, the Netherlands., Pim B Olthof, PierieJean-Pierre E NJENDepartment of Surgery, MC Leeuwarden, Leeuwarden, the Netherlands., Victor D Plat, Camiel Rosman, Jelle P Ruurda, Johanna W van Sandick, Meindert N Sosef, Daan M Voeten, Guy H E J Vijgen, Maarten F Bijlsma, Sybren L Meijer, HulshofMaarten C C MMCCMCancer Centre Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands.Department of Radiotherapy, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands., Cesar Oyarce, Sjoerd M Lagarde, van LaarhovenHanneke W MHWMCancer Centre Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands.Department of Medical Oncology, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands., Mark I van Berge Henegouwen, and IVORY study group .
• Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands.
• Br J Surg. 2024 Jan 31; 111 (2).

BackgroundThis 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.MethodsThis 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.ResultsAmong 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).ConclusionImproved 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.© The Author(s) 2024. Published by Oxford University Press on behalf of BJS Foundation Ltd.

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