BACKGROUND:Propensity score (PS) regression analysis can be used to minimize differences between cohorts in order to perform comparisons The aim of this study was to use PS analysis to examine the outcomes of oesophageal adenocarcinoma (OAC) treatment with surgery alone or neoadjuvant chemotherapy (NAC) followed by surgery (NACS), to see whether the benefits seen in a randomized trial (MRC OE02) were reproducible in a UK cancer network clinical practice.METHODS:Consecutive patients undergoing potentially curative treatment for OAC in a regional cancer network were studied. Multiple regression models, including PS analysis, were developed to account for confounding factors. Primary outcome measures were disease-free (DFS) and overall (OS) survival.RESULTS:A cohort of 440 patients was included in a regression analysis controlling for confounders (176 surgery alone, 264 NACS). NACS was associated with a higher positive margin status rate compared with surgery alone (42·4 versus 26·7 per cent respectively; P < 0·001), an inferior 5-year DFS rate (32·1 versus 56·9 per cent; P < 0·001) and a worse 5-year OS rate (27·5 versus 47·3 per cent; P < 0·001). On regression adjustment based on propensity scores, NACS was not associated with DFS (P = 0·220) or OS (P = 0·431). The Mandard tumour regression grade (TRG) score was significantly associated with DFS (hazard ratio (HR) 0·21, 95 per cent c.i. 0·07 to 0·70) and OS (HR 0·27, 0·13 to 0·59). Five-year DFS and OS rates related to TRG were 64 and 62 per cent respectively for 25 good responders versus 8·0 and 8·6 per cent for 127 poor responders (P < 0·001).CONCLUSION:The prescription of NAC to all patients with OAC risks delay in effective treatment of patients who are relatively chemoresistant, given the variability in pathological response. Identification of patients with OAC who may derive the most benefit from NAC should be the focus.

The aim of this study was to determine the influence of the Index of Multiple Deprivation (IMD) and Health Deprivation (HD) on upper gastrointestinal (UGI) cancer outcome. Consecutive 1185 patients (697 oesophageal, 488 gastric cancer) were studied prospectively. Deprivation scores were calculated using the IMD of the Welsh Government. Mortality data were obtained from the Office for National Statistics (ONS) and this data, as well as survival data, were independently verified by the Welsh Cancer Intelligence and Surveillance Unit. Primary outcome measure was survival from diagnosis. Median survival for gastric cancer patients was 8 months (0.25 to 64) compared with 10 months (0.25 to 62) for oesophageal cancer patients. Open and close laparotomy for all surgical patients was commoner in patients residing in deprived geographical areas with a 6.5% open and close rate in the least deprived IMD quintile versus 13.5% in the most deprived quintile (P=0.006). On post-operative histopathology, IMD was associated with pT (r=-0.146, P=0.043), pN (r =-0.158, P=0.029), and pM stage (r=-0.189, P=0.016). On univariate analysis survival was associated with oesophageal versus gastric tumour site (P=0.028), histopathological cell type (P<0.0001), age (P<0.0001), radiological (r) TNM stage (P<0.0001), radical treatment intent (P<0.0001), IMD (P<0.0001) and HD (P<0.0001). On multivariate analysis age (HR 1.021, 95% CI, 1.0141.028, P<0.0001), rTNM stage (HR 1.559, 95% CI, 1.427-1.704 P<0.0001), radical treatment intent (HR 0.338, 95% CI, 0.274-0.418, P<0.0001), and IMD rank (HR 1.000, 95% CI, 1.000-1.000, P=0.084) were associated with duration of survival. In conclusion deprivation is an important prognostic indicator in UGI cancer.

The aim of this study was to examine the influence of an enhanced recovery programme (ERP) on outcomes of upper gastrointestinal (UGI) cancer surgery by means of propensity score-matched analysis.

Introduction Recent public awareness campaigns for symptoms of cancer aim to improve outcomes by diagnosing cancer at an earlier stage. Whilst it is known that stage of disease at diagnosis predicts survival, the prognostic significance of delays in diagnosis and treatment of upper GI cancer is hitherto unknown. Method A prospective study of 150 consecutive upper GI cancer patients [median age 70 yr, 96 male, 102 oesophageal, 48 gastric cancer] presenting to a UK cancer network was performed. Duration of symptoms prior to patient presentation, and times between referral, investigations, diagnosis, and treatment commencement were recorded. Deprivation scores were obtained from the Welsh Indices of Multiple Deprivation (WIMD). Outcome measures were whether potentially curative therapy was possible at time of decision to treat (DTT), and overall survival. Results Median time from onset of symptoms to DTT was 18 weeks (3–143). There was no significant correlation between length of time from symptom onset to DDT and potentially curable disease (Chi26.809, p = 0.146). There was no significant difference in overall survival according to length of time from onset of symptoms to DDT (Chi24.209, p = 0.378). On multivariable analysis, gender (HR 3.600, 95% CI 1.659–7.811, p = 0.001) and overall deprivation rank (HR 1.001, 95% CI 1.000–1.001, p = 0.012) were significantly and independently associated with length of time from symptom onset to DDT. Conclusion Whilst diagnostic and treatment delays can be lengthy, there is no significant overall effect on rates of potentially curable disease or survival. Disclosure of interest None Declared.

The ideal shape and duration of UK core surgical training (CST) remains controversial and, despite national recruitment and standardised assessments, there is little uniformity across deaneries when it comes to CsT rotation structure. Moreover, many discrepancies exist in the duration of individual placements, the provision of themed rotations and even the total duration of training. 1,2

BACKGROUND:The role of treatments involving surgery versus definitive chemoradiotherapy (dCRT) for oesophageal cancer remains controversial.METHODS:Consecutive patients with oesophageal cancer were studied. Those whose treatment involved surgery alone or who received neoadjuvant chemotherapy or chemoradiotherapy were compared with those receiving dCRT. Multiple regression models, including propensity scores, were developed to assess confounding factors associated with undergoing surgery or dCRT, and the risk-adjusted association between treatment and survival.RESULTS:From a total of 727 patients, regression adjustment to control for bias created a cohort of 521 patients available for comparison (277 in the surgery group and 244 in the dCRT group). Local and distant recurrence rates were 10·1 and 22·0 per cent respectively after surgery, compared with 26·2 and 11·9 per cent following dCRT (P < 0·001). Median survival, and 2- and 5-year survival rates after surgery were 27 months, 53·8 and 31·0 per cent respectively, compared with 28 months, 54·2 and 31·9 per cent after dCRT (P = 0·918). On multivariable analysis, disease-free survival was related to endosonographic tumour category (hazard ratio (HR) 0·76, 95 per cent confidence interval 0·10 to 6·04 for T1; HR 1·57, 0·21 to 11·58 for T2; HR 2·12, 0·29 to 15·49 for T3; HR 3·07, 0·41 to 23·16 for T4; P = 0·003, in relation to T0 as reference), lymph node metastasis count (HR 1·10, 1·04 to 1·15; P < 0·001) and total disease length (HR 0·96, 0·93 to 1·00; P = 0·041).CONCLUSION:There was no difference in survival after oesophageal cancer treatment involving surgery or dCRT.

AIM: To assess whether separate endoscopic ultrasound (EUS) lymph node (N)-staging is still of prognostic value in those staged node negative (NO) at combined positron-emission tomography/computed tomography (PET/CT) in patients with oesophageal cancer (OC).MATERIALS AND METHODS: One hundred and seventeen consecutive patients [median age 67 years; 88 male; 98 cases of adenocarcinoma, 19 cases of squamous cell carcinoma (SCC)] staged as NO at PET/CT underwent EUS to record tumour (T)- and N-stage. The patients were subsequently separated into two groups: EUS NO (n = 78) and EUS N+ (n = 39). Survival analysis using Kaplan-Meier and Cox's proportional hazard methods was performed. Primary outcome was overall survival from diagnosis.RESULTS: EUS N-stage and EUS NO versus EUS N+ (p = 0.005 and p = 0.001, respectively) were found to be significantly and independently associated with survival in two models of multivariate analysis, in patients staged NO at PET/CT. EUS T-stage was significantly associated with survival on univariate analysis.CONCLUSION: EUS N-staging still has prognostic value in patients staged NO at PET/CT. There is a significant difference in survival between EUS NO and positive nodal EUS status in those staged NO at PET/CT, suggesting PET/CT is unreliable for local staging. PET/CT and EUS continue to have complimentary roles in OC staging. Crown Copyright (C) 2014 Published by Elsevier Ltd on behalf of The Royal College of Radiologists. All rights reserved.