Prognostic value of Mandard score and nodal status for recurrence patterns and survival after multimodal treatment of oesophageal adenocarcinoma

Sofie P.G. Henckens, Dajia Liu, Suzanne S. Gisbertz, Marianne C. Kalff, Maarten C.J. Anderegg, David Crull, Freek Daams, Annette D. van Dalsen, Jan Willem T. Dekker, Marc J. van Det, Peter van Duijvendijk, Wietse J. Eshuis, Richard P.R. Groenendijk, Jan Willem Haveman, Richard van Hillegersberg, Misha D.P. Luyer, Pim B. Olthof, Jean Pierre E.N. Pierie, Victor D. Plat, Camiel RosmanJelle P. Ruurda, Johanna W. van Sandick, Meindert N. Sosef, Daan M. Voeten, Guy H.E.J. Vijgen, Maarten F. Bijlsma, Sybren L. Meijer, Maarten C.C.M. Hulshof, Cesar Oyarce, Sjoerd M. Lagarde, IVORY study group , Hanneke W.M. van Laarhoven, Mark I. van Berge Henegouwen*

*Corresponding author for this work

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This study evaluated the association of pathological tumour response (tumour regression grade, TRG) and a novel scoring system, combining both TRG and nodal status (TRG-ypN score; TRG1-ypN0, TRG>1-ypN0, TRG1-ypN+ and TRG>1-ypN+), with recurrence patterns and survival after multimodal treatment of oesophageal adenocarcinoma. 


This Dutch nationwide cohort study included patients treated with neoadjuvant chemoradiotherapy followed by oesophagectomy for distal oesophageal or gastro-oesophageal junctional adenocarcinoma between 2007 and 2016. The primary endpoint was the association of Mandard score and TRG-ypN score with recurrence patterns (rate, location, and time to recurrence). The secondary endpoint was overall survival. 


Among 2746 inclusions, recurrence rates increased with higher Mandard scores (TRG1 30.6%, TRG2 44.9%, TRG3 52.9%, TRG4 61.4%, TRG5 58.2%; P < 0.001). Among patients with recurrent disease, the distribution (locoregional versus distant) was the same for the different TRG groups. Patients with TRG1 developed more brain recurrences (17.7 versus 9.8%; P = 0.001) and had a longer mean overall survival (44 versus 35 months; P < 0.001) than those with TRG>1. The TRG>1-ypN+ group had the highest recurrence rate (64.9%) and worst overall survival (mean 27 months). Compared with the TRG>1-ypN0 group, patients with TRG1-ypN+ had a higher risk of recurrence (51.9 versus 39.6%; P < 0.001) and worse mean overall survival (33 versus 41 months; P < 0.001). 


Improved tumour response to neoadjuvant therapy was associated with lower recurrence rates and higher overall survival rates. Among patients with recurrent disease, TRG1 was associated with a higher incidence of brain recurrence than TRG>1. Residual nodal disease influenced prognosis more negatively than residual disease at the primary tumour site.

Original languageEnglish
Article numberznae034
JournalThe British journal of surgery
Issue number2
Publication statusPublished - 1 Feb 2024

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