P-079 - Impact of disease biology and stage on outcomes for oesophageal and gastric adenocarcinoma (OGA) treated with neoadjuvant chemotherapy

Date 04 July 2015
Event WorldGI 2015
Session Posters
Topics Anti-Cancer Agents & Biologic Therapy
Oesophageal Cancer
Gastric Cancer
Pathology/Molecular Biology
Presenter E. Fontana
Citation Annals of Oncology (2015) 26 (suppl_4): 1-100. 10.1093/annonc/mdv233
Authors E. Fontana1, D. Cunningham2, E. Smyth1, F. Morano1, S. Rao1, D. Watkins1, W. Allum1, J. Thompson1, T. Waddell3, S.Y. Moorcraft1, C. Peckitt1, N. Starling1, I. Chau4
  • 1The Royal Marsden NHS Foundation Trust, Sutton/UK
  • 2Royal Marsden NHS Foundation Trust, Sutton/UK
  • 3Royal Marsden Hospital, London/UK
  • 4Royal Marsden Hospital, Sutton/UK

Abstract

Introduction

OGA is a lethal cancer globally. After two UK MRC trials (MAGIC and OEO2) were published, neoadjuvant and peri-operative treatments became standard practice for OGA at the Royal Marsden Hospital. After neoadjuvant treatment, the identification of factors to evaluate individual patient risk is compulsory for early identification of patients (pts) with poor prognosis. Aim of this analysis was to identify predictors of survival after surgical resection in pts treated with neoadjuvant approach.

Methods

Electronic records of all pts who had undergone surgery with radical intent for OGA between 01/2001 and 12/2010 were reviewed. Pts that received neoadjuvant treatment were identified. Pt age, sex, ECOG PS, pre-operative staging investigations (CT, EUS, PET-CT), perioperative therapy, type of surgery, pathological stage, lymph nodes collected, resection margins, grade, Lauren classification, vascular, lymphatic, neural invasion, tumour regression grade, lymphocytic infiltrate, dates of disease relapse, death, last follow up and treatment for recurrent disease were recorded. Disease-free survival (DFS) and OS were estimated using the Kaplan Meier method; co-variates were compared using the log rank test and hazard ratios calculated using Cox regression model. Variables with more than 50% of data missing were excluded in multivariate analysis (MVA).

Results

262 pts were identified. Median age was 64 (range 33-82); 81% were male. The primary tumour was gastric in 67% and oesophageal or junctional in 33% of cases. Oesophago-gastrectomy, partial gastrectomy or total gastrectomy were performed in 57, 16 and 27%, respectively. 41% of pts received cisplatin and fluoropyrimidine-based doublet and 59% received triplet with anthracycline. R0 resection rate was 80%. 86% of pts had more than 15 lymph nodes collected. 59% of tumours were staged T 0-2; 51% were lymph nodes positive. Seven pts had M1 disease resection at the time of surgery. 42% of pts received adjuvant treatment. 37% of pts with positive resection margins received chemoradiation.

After a median follow-up of 66.1 months (95% CI, 61.3 -72), median DFS and OS were respectively 31.7 (95% CI, 23.9-43.6) and 53.5 (95% CI, 39.8-77.7) months. In univariate analysis, oesophageal or junctional tumours, poorly differentiated, elevated tumour markers at diagnosis, R+ resection, T3-4, N + , M1 stage, non-intestinal subtype, presence of lymphatic or neural or vascular invasion were significantly associated with worse DFS and OS. With the limit of small number of pts (99) with complete data for MVA, oesophageal or junctional tumours, T3-4 stage, non-intestinal subtype, presence of lymphatic invasion were independent predictors of worse DFS. Oesophageal or junctional site, T3-4 stage, N+ and non-intestinal subtype were independent predictors of worse OS.

Conclusion

In this large retrospective study, underlying disease biology (oesophageal or junctional site and non-intestinal subtype) in addition to pathological stage were negative independent predictors of DFS and OS for OGA. Future clinical trials may stratify pts according to these characteristics in order to optimise post-operative treatment.