Retrospective Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 7, 2018; 24(13): 1429-1439
Published online Apr 7, 2018. doi: 10.3748/wjg.v24.i13.1429
Impact of postoperative TNM stages after neoadjuvant therapy on prognosis of adenocarcinoma of the gastro-oesophageal junction tumours
Michael Thomaschewski, Richard Hummel, Ekaterina Petrova, Juliana Knief, Ulrich Friedrich Wellner, Tobias Keck, Dirk Bausch
Michael Thomaschewski, Richard Hummel, Ekaterina Petrova, Ulrich Friedrich Wellner, Tobias Keck, Dirk Bausch, Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck 23538, Germany
Juliana Knief, Department of Pathology, University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck 23538, Germany
Author contributions: Thomaschewski M, Hummel R and Bausch D drafted the original manuscript, contributed to design of the study, performance of statistical analyses and interpretation of the results; Petrova E collected the data; Wellner UF performed, reviewed and approved the statistical analyses; Keck T contributed to the design of the study and critically revised the manuscript for important intellectual content; all authors read and approved the final manuscript.
Supported by Land Schleswig-Holstein within the funding programme Open Access Publikationsfonds.
Institutional review board statement: The study was reviewed and approved by the institutional ethics committee (Ethik-Kommission Universität zu Lübeck/Aktenzeichen: 17-379A).
Conflict-of-interest statement: All authors declare no conflict-of-interest related to this article.
Data sharing statement: Consent for data sharing was not obtained and the data are not available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Michael Thomaschewski, MD, Doctor, Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany. michael.thomaschewski@uksh.de
Telephone: +49-451-50040220 Fax: +49-451-5002069
Received: January 22, 2018
Peer-review started: January 22, 2018
First decision: February24, 2018
Revised: March 6, 2018
Accepted: March 10, 2018
Article in press: March 10, 2018
Published online: April 7, 2018
Processing time: 72 Days and 12.2 Hours
Abstract
AIM

To compare prognostic relevance of postoperative tumour/node/metastasis (TMN) stages between patients with and without neoadjuvant treatment.

METHODS

Data from patients with adenocarcinoma of the gastro-oesophageal junction (AEG) who had undergone surgical resection at a single German university centre were retrospectively analysed. Patients with or without neoadjuvant preoperative treatment were selected by exact matching based on preoperative staging. Standard assessment of preoperative (c)TNM stage was based on endoscopic ultrasound and computed tomography of the thorax and abdomen, according to the American Joint Committee on Cancer/Union for International Cancer Control classification system. Patients with cT1cN0cM0 and cT2cN0cM0 stages were excluded from the study, as these patients are generally not recommended for pretreatment. Long-term survival among the various postoperative TNM stages was compared between the groups of patients with or without neoadjuvant treatment. For statistical assessments, a P-value of ≤ 0.05 was considered significant.

RESULTS

The study included a total of 174 patients. The group of patients who had received preoperative neoadjuvant treatment included more cases of AEG (Siewert) type 1 carcinoma (P < 0.001), and consequently oesophagectomy was performed more frequently among these patients (P < 0.001). The two groups (with or without preoperative neoadjuvant treatment) had comparable preoperative T stages, but the group of patients with preoperative neoadjuvant treatment presented a higher rate of preoperative N-positive disease (P = 0.020). Overall long-term survival was not different between the two groups of patients according to tumours of different AEG classifications, receipt of oesophagectomy or gastrectomy, nor between patients with similar postoperative TNM stage, resection margin and grading. However, an improvement of long-term survival was found for patients with nodal down-staging after neoadjuvant therapy (P = 0.053).

CONCLUSION

The prognostic relevance of postoperative TNM stages is similar for AEG in patients with or without neoadjuvant preoperative treatment, but treatment-related nodal down-staging prognosticates longer-term survival.

Keywords: Adenocarcinoma of the gastro-oesophageal junction; American Joint Committee on Cancer/Union for International Cancer Control; TNM system; Neoadjuvant therapy; Oesophageal cancer

Core tip: Neoadjuvant therapy is the standard treatment for locally advanced adenocarcinoma of the gastro-oesophageal junction (AEG). Prognosis of AEG is based mainly on postoperative tumour/node/metastasis (TNM) stages, using the American Joint Committee on Cancer/Union for International Cancer Control classification system. Yet, whether prognostication based on postoperative TNM stage is affected by preoperative neoadjuvant therapy is unclear. Retrospective analysis of 174 patients showed that the prognostic relevance of postoperative TNM stage is independent of preoperative neoadjuvant therapy. However, nodal down-stage response following neoadjuvant therapy was found to result in improvement of survival.