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Histological prognosticators in neoadjuvant naive oesophageal cancer patients

Lookup NU author(s): Dr Jakub Chmelo, Dr Maziar Navidi, Professor Alexander PhillipsORCiD


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© 2023, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.Purpose: Prognosis of oesophageal cancer is primarily based upon the TNM stage of the disease. However, even in those with similar TNM staging, survival can be varied. Additional histopathological factors including venous invasion (VI), lymphatic invasion (LI) and perineural invasion (PNI) have been identified as prognostic markers yet are not part of TNM classification. The aim of this study is to determine the prognostic importance of these factors and overall survival in patients with oesophageal or junctional cancer who underwent transthoracic oesophagectomy as the unimodality treatment. Methods: Data from patients who underwent transthoracic oesophagectomy for adenocarcinoma without neoadjuvant treatment were reviewed. Patients were treated with radical resection, with a curative intent using a transthoracic Ivor Lewis or three staged McKeown approach. Results: A total of 172 patients were included. Survival was poorer when VI, LI and PNI were present (p<0.001), with the estimated survival being significantly worse (p<0.001) when patients were stratified according to the number of factors present. Univariable analysis of factors revealed VI, LI and PNI were all associated with survival. Presence of LI was independently predictive of incorrect staging/upstaging in multivariable logistic regression analysis (OR 12.9 95% CI 3.6–46.6, p<0.001). Conclusion: Histological factors of VI, LI and PNI are markers of aggressive disease and may have a role in prognostication and decision-making prior to treatment. The presence of LI as an independent marker of upstaging could be a potential indication for the use of neoadjuvant treatment in patients with early clinical disease.

Publication metadata

Author(s): Hardy K, Chmelo J, Joel A, Navidi M, Fergie BH, Phillips AW

Publication type: Article

Publication status: Published

Journal: Langenbeck's Archives of Surgery

Year: 2023

Volume: 408

Issue: 1

Online publication date: 09/05/2023

Acceptance date: 30/04/2023

ISSN (print): 1435-2443

ISSN (electronic): 1435-2451

Publisher: Springer Science and Business Media Deutschland GmbH


DOI: 10.1007/s00423-023-02927-z

PubMed id: 37156834


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