Dear Editor
We thank our colleagues for their interest in our manuscript1 and the opportunity to reply to their correspondence.
In reply to the first point, we agree that tumour regression grade (TRG) or other measures of response to chemotherapy would have been beneficial in interpreting the results of this study. It is unfortunately however not a data point collected within the National Oesophago-gastric Cancer Audit (NOGCA) and hence unavailable for this study. This is acknowledged as a limitation within the manuscript. Nonetheless, the close relationship between circumferential resection margin, ypT/ypN stage, and TRG would be expected to mitigate the absence of TRG in the propensity score model. Similarly, direct data on chemotherapy toxicity were not available in our data. We included time from diagnosis to surgery and number of cycles received pre-surgery as surrogate markers of patient tolerance to preoperative treatment, which again should help to reduce the importance of these missing data.
Acknowledgements
The study was undertaken as part of the work by the National Oesophago-Gastric (OG) Cancer Audit. The Audit is commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit and Patient Outcomes Programme. The authors had full independence from the Healthcare Quality Improvement Partnership. The aim of National Oesophago-Gastric Cancer Audit is to evaluate the care of patients with OG cancer in England and Wales, and support NHS providers to improve the quality of hospital care for these patients. More information can be found at: www.nogca.org.uk.
Contributor Information
Saqib A Rahman, School of Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton, UK; Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK.
Timothy J Underwood, School of Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.
Funding
The Audit is funded by NHS England and the Welsh Government (www.hqip.org.uk/national-programmes).
Reference
- 1. Rahman S, Thomas B, Maynard N, Park MH, Wahedally M, Trudgill N et al. Impact of postoperative chemotherapy on survival for oesophagogastric adenocarcinoma after preoperative chemotherapy and surgery. Br J Surg 2022;109:227–236 [DOI] [PMC free article] [PubMed] [Google Scholar]