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  • Turkington, Richard C; Knight, Laura A; Blayney, Jaine K; Secrier, Maria; Douglas, Rosalie; Parkes, Eileen E; Sutton, Eilis K; Stevenson, Leanne; McManus, Damian; Halliday, Sophia; McCavigan, Andrena M; Logan, Gemma E; Walker, Steven M; Steele, Christopher J; Perner, Juliane; Bornschein, Jan; MacRae, Shona; Miremadi, Ahmad; McCarron, Eamon; McQuaid, Stephen; Arthur, Kenneth; James, Jacqueline A; Eatock, Martin M; O'Neill, Robert; Noble, Fergus; Underwood, Timothy J; Harkin, D Paul; Salto-Tellez, Manuel; Fitzgerald, Rebecca C; Kennedy, Richard D

    Gut, 11/2019, Letnik: 68, Številka: 11
    Journal Article

    Current strategies to guide selection of neoadjuvant therapy in oesophageal adenocarcinoma (OAC) are inadequate. We assessed the ability of a DNA damage immune response (DDIR) assay to predict response following neoadjuvant chemotherapy in OAC. Transcriptional profiling of 273 formalin-fixed paraffin-embedded prechemotherapy endoscopic OAC biopsies was performed. All patients were treated with platinum-based neoadjuvant chemotherapy and resection between 2003 and 2014 at four centres in the Oesophageal Cancer Clinical and Molecular Stratification consortium. CD8 and programmed death ligand 1 (PD-L1) immunohistochemical staining was assessed in matched resection specimens from 126 cases. Kaplan-Meier and Cox proportional hazards regression analysis were applied according to DDIR status for recurrence-free survival (RFS) and overall survival (OS). A total of 66 OAC samples (24%) were DDIR positive with the remaining 207 samples (76%) being DDIR negative. DDIR assay positivity was associated with improved RFS (HR: 0.61; 95% CI 0.38 to 0.98; p=0.042) and OS (HR: 0.52; 95% CI 0.31 to 0.88; p=0.015) following multivariate analysis. DDIR-positive patients had a higher pathological response rate (p=0.033), lower nodal burden (p=0.026) and reduced circumferential margin involvement (p=0.007). No difference in OS was observed according to DDIR status in an independent surgery-alone dataset.DDIR-positive OAC tumours were also associated with the presence of CD8+ lymphocytes (intratumoural: p<0.001; stromal: p=0.026) as well as PD-L1 expression (intratumoural: p=0.047; stromal: p=0.025). The DDIR assay is strongly predictive of benefit from DNA-damaging neoadjuvant chemotherapy followed by surgical resection and is associated with a proinflammatory microenvironment in OAC.