Br J Cancer: Mandard grade is high: it does not mean that esophageal adenocarcinoma does not respond to chemotherapy

Neoadjuvant therapy has now become the standard of treatment for esophageal cancer.
The good response of patients to neoadjuvant therapy is closely related to the improvement of survival rate.
The Mandard tumor regression grading standard is the current measure of response to chemotherapy.

A high Mandard grade means that esophageal adenocarcinoma does not respond to chemotherapy.
However, some patients with higher grades still show a decrease in tumor volume and lymph node response.
Therefore, the study aims to explore the survival status and disease recurrence patterns of these patients.

Researchers used multivariate Cox regression analysis to assess the patient's time to death and recurrence, and analyze related clinicopathological factors.
And through computed tomography technology to evaluate the volume change of the tumor.

Kaplan-Meier survival curve analysis of each lymph node response group

The study included a total of 555 patients.
The results showed that the patients' median survival time was 55 months (Mandard grades 1-3) and 21 months (Mandard grades 4 and 5).
In the Mandard grade 4 and 5 groups (332 patients), the researchers compared patients with complete lymph node response and patients with persistent lymphadenopathy.
The results showed that the survival rate of patients (90 months vs.
18 months), The recurrence rate (local area 14.
75% vs.
28.
74%, systemic 24.
59% vs.
48.
42%) and the positive rate of circumferential margins (22.
95% vs.
68.
11%) were improved.
Further studies have shown that complete lymph node response is an independent predictor of improvement in patient survival (hazard ratio 0.
34).
Patients with complete lymph node response had a greater reduction in tumor volume after chemotherapy, and there was no significant difference between different Mandard grades.

Kaplan-Meier analysis of patients' relapse-free survival rate

All in all, the results of the study show that in patients with poor Mandard grade, complete lymph node response can significantly improve patient outcomes.
Therefore, a high Mandard grade does not mean that patients do not respond to chemotherapy, and patients with slowed lymph node metastasis can still benefit from adjuvant chemotherapy.

Original source:

Knight, WRC, Baker, CR, Griffin, N.