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Complete pathological response is predictive for clinical outcome after tri-modality therapy for carcinomas of the superior pulmonary sulcus

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Abstract

The objective was to define the relationship between histopathological changes after pre-operative chemo-radiotherapy (CRT) and clinical outcome following tri-modality therapy in patients with superior sulcus tumours. A retrospective analysis of tumour material was performed in a series of 46 patients who received tri-modality therapy between 1997 and 2007. Median follow-up was 34 months (5–154). Pathological complete response (pCR) was present in 20/46 tumours (43 %). The most common RECIST score after CRT in patients with pCR was a partial response (PR; 10/17, three unknown), whereas in patients without a pCR, stable disease was the most common (22/26) (p = 0.002). In 26 specimens with residual tumour, this was mainly located in the periphery of the lesion rather than the centre (Spearman’s correlation = 0.67, p < 0.001). Prognosis was significantly better after a pCR compared to residual tumour (70 % 5-year overall survival vs. 20 %; p = 0.001) and in patients with fewer than 10 % vital tumour cells as compared to those with >10 % (65 % 5-year overall survival vs. 18 %; p < 0.001). A low mitotic count was associated with a longer disease-free survival (p = 0.02). Complete pathological response and the presence of fewer than 10 % vital tumour cells after pre-operative CRT are both associated with a more favourable prognosis. A modification of the pathological staging system after radiotherapy, incorporating the percentage of vital tumour cells, is proposed.

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Conflict of interest

None of the authors has any conflict of interest regarding the research discussed.

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Authors and Affiliations

  1. Department of Pathology, Onze Lieve Vrouwe Gasthuis, Oosterpark 9, 1090, HM, Amsterdam, The Netherlands

    Johannes L. Blaauwgeers

  2. Department of Surgery, Netherlands Cancer Institute (NKI-AVL), Amsterdam, The Netherlands

    Ingrid Kappers & Houke M. Klomp

  3. Department of Radiotherapy, Netherlands Cancer Institute (NKI-AVL), Amsterdam, The Netherlands

    José S. Belderbos

  4. Department of Teaching Hospital, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands

    Lea M. Dijksman

  5. Department of Pulmonology, VU University Medical Center (VUmc), Amsterdam, The Netherlands

    Egbert F. Smit & Pieter E. Postmus

  6. Department of Surgery, VU University Medical Center (VUmc), Amsterdam, The Netherlands

    Marinus A. Paul, Jan W. Oosterhuis, Koen J. Hartemink & Cornelis G. Vos

  7. Department of Pulmonology, Netherlands Cancer Institute (NKI-AVL), Amsterdam, The Netherlands

    Jacobus A. Burgers

  8. Department of Radiation Oncology, VU University Medical Center (VUmc), Amsterdam, The Netherlands

    Max Dahele & Erik C. Phernambucq

  9. Department of Epidemiology and Biostatistics, VU University Medical Center (VUmc), Amsterdam, The Netherlands

    Birgit I. Witte

  10. Department of Pathology, VU University Medical Center (VUmc), Amsterdam, The Netherlands

    Erik Thunnissen

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  1. Johannes L. Blaauwgeers
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  2. Ingrid Kappers
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  4. José S. Belderbos
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  5. Lea M. Dijksman
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  8. Marinus A. Paul
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  9. Jan W. Oosterhuis
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  10. Koen J. Hartemink
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  11. Cornelis G. Vos
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  12. Jacobus A. Burgers
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  13. Max Dahele
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  14. Erik C. Phernambucq
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  15. Birgit I. Witte
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  16. Erik Thunnissen
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Correspondence to Johannes L. Blaauwgeers.

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Blaauwgeers, J.L., Kappers, I., Klomp, H.M. et al. Complete pathological response is predictive for clinical outcome after tri-modality therapy for carcinomas of the superior pulmonary sulcus. Virchows Arch 462, 547–556 (2013). https://doi.org/10.1007/s00428-013-1404-6

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  • DOI: https://doi.org/10.1007/s00428-013-1404-6

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