Introduction Patients who demonstrate a histological response to chemotherapy as determined by tumour regression grading (TRG) are known to have improved survival.1 2 We report current survival expectations for patients following neo-adjuvant chemotherapy and resection of gastro-oesophageal cancer.
Methods TRG was determined by a specialist pathologist in 250 patients after chemotherapy, and survival outcomes were assessed by Kaplan–Meier analysis of patients divided into responder (Mandard TRG 1–3) and non-responder (TRG 4&5) groups, with log-rank comparisons.
Results After a median follow-up of 54.4 months survival was found to be improved in those with histological response to chemotherapy (p<0.001). Median survival was estimated to be 34.0 months and 21.2 months in oesophageal adenocarcinoma responders and non-responders and this was statistically significant (p=0.050). Junctional cancers demonstrated the largest survival difference at 51.1 months compared to 24.6 months (p=0.003). In gastric cancers the median survival was yet to be reached for responders and was 35.2 months for non-responders. However, smaller numbers in this group led to loss of statistical power (p=0.166). A higher proportion of patients with good response to chemotherapy was not seen using MAGIC regimen (Pearson χ2 p=0.616). Good response to chemotherapy (TRG1-3) was associated with lower incidence of positive CRM (p=0.021)
Conclusion Tumour regression grading is a useful predictor of overall survival allowing clinicians greater ability to counsel their patients. However, MAGIC therapy appears to improve survival possibly through mechanisms other than simply increasing the proportion of patients that have histological response.
Competing interests None declared.
References 1. Becker, et al. Ann Surg 2011;253:934–9.
2. Fareed, et al. Histopathology 2009;55:399–406.