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World J Gastroenterol. Dec 28, 2013; 19(48): 9282-9293
Published online Dec 28, 2013. doi: 10.3748/wjg.v19.i48.9282
Published online Dec 28, 2013. doi: 10.3748/wjg.v19.i48.9282
Refining pathological evaluation of neoadjuvant therapy for adenocarcinoma of the esophagus
Fergus Noble, Luke Nolan, Tim J Underwood, Andrew R Bateman, Cancer Sciences Unit, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, United Kingdom
Adrian C Bateman, Department of Cellular Pathology, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, United Kingdom
Fergus Noble, James P Byrne, Jamie J Kelly, Ian S Bailey, Donna M Sharland, Tim J Underwood, Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, United Kingdom
Charlotte N Rees, Timothy J Iveson, Andrew R Bateman, Cancer Care, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, United Kingdom
Author contributions: Noble F and Nolan L contributed equally to this study; Noble F collected the data and analysed it; Noble F, Nolan L, Underwood TJ and Bateman AR wrote the manuscript; Bateman AC scored the initial patients for pathological regression before this was adopted by the multidisciplinary team; Underwood TJ and Bateman AR had overall responsibility for the scientific content of the manuscript; all authors conceived jointly the idea for the manuscript and contributed to the analysis and reviewed and edited the text.
Supported by A clinical research training fellowship from Cancer Research UK to Noble F; A Medical Research Council (United Kingdom) clinician scientist fellowship to Underwood TJ
Correspondence to: Dr. Andrew R Bateman, Lecturer, Consultant, Clinical Oncologist, Cancer Sciences Unit, Faculty of Medicine, University of Southampton, Somers Cancer Research Building, MP824, Tremona Road, Southampton SO16 6YD, United Kingdom. a.r.bateman@soton.ac.uk
Telephone: +44-23-80796184-6670 Fax: +44-23-80795152
Received: April 26, 2013
Revised: July 12, 2013
Accepted: July 23, 2013
Published online: December 28, 2013
Revised: July 12, 2013
Accepted: July 23, 2013
Published online: December 28, 2013
Core Tip
Core tip: Predictive markers of benefit from neoadjuvant chemotherapy (NAC) in esophageal adenocarcinoma are urgently required to provide a “personalised medicine” approach: directing treatment to those most likely to benefit. Before prospective studies can be initiated, retrospective series need to be interrogated to identify likely candidate markers of a positive response. In defining a positive response attention needs to be given to both response in the primary tumour and in the lymph nodes, as a previously unidentified group of patients who appear to have a poor tumoural response to NAC (tumour regression grade 3-5) do benefit from combination therapy by nodal downstaging.