Prognostic classification of histopathologic response to neoadjuvant therapy in esophageal adenocarcinoma.

[esophageal adenocarcinoma]

To evaluate the histopathologic response to neoadjuvant therapy in esophageal adenocarcinoma according to impact on prognosis and to suggest a classification for clinical routine .Measures of histopathologic response to neoadjuvant treatment of esophageal cancer such as Mandard tumor regression grading focus on the effect on the primary tumor . Although lymph node infiltration is of significant prognostic importance , this criterion is mostly not included in the response classifications .A total of 370 patients (89 % males , median age : 61 years ) with neoadjuvant radiochemotherapy (40 Gy , 5 -FU , cisplatin ) or chemotherapy (MAGIC or FLOT ) for cT 3 , Nx , M 0 esophageal adenocarcinoma were included in the analysis . All patients had undergone transthoracic en bloc esophagectomy , with a median of 27 resected lymph nodes and a R 0 -resection rate of 92 %. Histopathologic regression grading differentiated major or minor response according to less or more than 10 % vital cells in the primary tumor . The lymph nodes were classified as ypN 0 or ypN +.From the patients with R 0 resection and M 0 category , 3 groups with significantly different 5 -year survival rates (5 -YSR ) could be differentiated :: A combined classification of primary tumor regression and lymph node status in 3 grades represents a simple and reproducible prognostic classification of the effect of neoadjuvant treatment in esophageal adenocarcinoma .