PATHOLOGIC FACTORS PROGNOSTIC OF SURVIVAL IN PATIENTS WITH GI TRACT AND PANCREATIC CARCINOMA TREATED WITH NEOADJUVANT THERAPY
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1 PATHOLOGIC FACTORS PROGNOSTIC OF SURVIVAL IN PATIENTS WITH GI TRACT AND PANCREATIC CARCINOMA TREATED WITH NEOADJUVANT THERAPY Jeannelyn S. Estrella, MD Department of Pathology The UT MD Anderson Cancer Center
2 ESOPHAGEAL ADENOCARCINOMA
3 ESOPHAGEAL ADENOCARCINOMA MD Anderson N=235 +neoadjuvant chemoxrt yptnm (AJCC 6 th ) Cancer Apr 1;103(7):
4 ESOPHAGEAL ADENOCARCINOMA yptnm (AJCC 6 th ) Cancer Apr 1;103(7):
5 ESOPHAGEAL ADENOCARCINOMA MD Anderson N=187 +neoadjuvant chemoxrt Number of +LN Cancer Mar 1;106(5):
6 ESOPHAGEAL ADENOCARCINOMA Memorial Sloan-Kettering N=276 +neoadjuvant chemoxrt Kaplan-Meier analyses: 0 to IIA (P=0.52) IIB to III (P=0.87) IVA to IVB (P=0.30) yptnm (AJCC 6 th ) J Clin Oncol Feb 10;25(5):507-12
7 ESOPHAGEAL ADENOCARCINOMA Memorial Sloan-Kettering N=276 +neoadjuvant chemoxrt Best predictors LN status metastasis J Clin Oncol Feb 10;25(5):507-12
8 ESOPHAGEAL ADENOCARCINOMA 2 high-volume centers in London N=584 patients N=400 +neoadjuvant tx Downstaging: HR=0.43, 95%CI strongest independent predictor Tumor downstaging J Clin Oncol Jul 28. pii: JCO
9 ESOPHAGEAL ADENOCARCINOMA Neuroendocrine differentiation Cancer Oct 1;107(7):
10 GASTRIC CARCINOMA
11 GASTRIC CARCINOMA <10% residual tumor MD Anderson N=41 +neoadjuvant chemoxrt localized gastric ca Margin status, pathologic response J Clin Oncol Feb 20;23(6):
12 GASTRIC CARCINOMA MD Anderson N=69 +neoadjuvant chemoxrt localized gastric ca AJCC stage (6 th ) Cancer Oct 1;107(7):
13 GASTRIC CARCINOMA TRG1 <10%, TRG %, TRG3 >50% UICC 2002 ypn Technische Universitat Munchen N=440 +neoadjuvant chemo locally advanced gastric ca Pathologic response, LN status Ann Surg May;253(5):934-9
14 PANCREATIC DUCTAL CARCINOMA
15 PANCREATIC DUCTAL CARCINOMA MD Anderson N=240 +neoadjuvant chemoxrt ypn1a: 1-3 +LN, ypn1b: >3 +LN AJCC stage (7 th ) Cancer Jan 1;118(1):268-77
16 PANCREATIC DUCTAL CARCINOMA MD Anderson N=225 patients +neoadjuvant chemoxrt PV/SMV involvement Cancer Aug 1;118(15):
17 PANCREATIC DUCTAL CARCINOMA MD Anderson N=212 patients +neoadjuvant chemoxrt +Muscular vessel Am J Surg Pathol Apr;36(4):552-9
18 PANCREATIC DUCTAL CARCINOMA MD Anderson N=223 +neoadjuvant chemoxrt Pathologic response Group 1: <5%, Group 2: 5% Cancer Jun 15;118(12):
19 RECTAL CARCINOMA
20 RECTAL CARCINOMA CAO/ARO/AIO-94 trial (multicenter randomized phase III study) N=402 +neoadjuvant chemoxrt Median follow-up: 132 months TRG: 0-no response, 1-25% fibrosis, % fibrosis, 3->50% fibrosis, 4-complete response TRG, ypn J Clin Oncol May 20;32(15):
21 RECTAL CARCINOMA Beaumont Hospital, Dublin, Ireland N=153 +neoadjuvant chemoxrt +adjuvant chemo T3/T4 +LN (locally advanced) Evaluated all TRG systems By multivariate analysis: ypn and margin not TRG ypn and margin Colorectal Dis Jan;16(1):O16-25
22 RECTAL CARCINOMA University of Alexandria, Egypt N=121 patients +neoadjuvant chemoxrt + adjuvant chemo Median follow-up: at least 5 years +margin: tumor extension (continuous and discontinuous) <2mm from ink Mesorectal resection status NOT a prognostic factor for recurrence Circumferential margin <2mm Am J Surg Sep;208(3):332-41
23 RECTAL CARCINOMA Sungkyunkwan University School of Medicine, Seoul, Korea N=181 +neoadjuvant chemoxrt Circumferential margin <1mm Dis Colon Rectum Aug;57(8):933-40
24 RECTAL CARCINOMA CAO/ARO/AIO-94 trial (multicenter randomized phase III study) N=124 +neoadjuvant chemoxrt Median follow-up: at least 5 years ypt3a: 5mm, ypt3b: >5mm ypt3b: HR 2.46, 95%CI , P=0.014 disease-specific survival ypt3a versus ypt3b Br J Surg Apr;101(5):566-72
25 PATHOLOGIC FACTORS PROGNOSTIC OF SURVIVAL Esophageal adenocarcinoma yptnm (AJCC 6 th ) conflicting studies LN and distant metastasis Tumor downstaging NE differentiation
26 PATHOLOGIC FACTORS PROGNOSTIC OF SURVIVAL Gastric carcinoma R0 resection Pathologic response Complete and <10% residual tumor yptnm (AJCC 6 th ) LN status (UICC 2002)
27 PATHOLOGIC FACTORS PROGNOSTIC OF SURVIVAL Pancreatic ductal carcinoma yptnm (AJCC 7 th ) LN status 0 vs 1-3 +LN vs >3 +LN +tumor in resected vein +invasion into muscular vessel Pathologic response <5% vs 5% residual tumor
28 PATHOLOGIC FACTORS PROGNOSTIC OF SURVIVAL Rectal carcinoma Tumor regression grade conflicting studies LN status R0 resection 1 mm vs 2 mm ypt3a vs ypt3b
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