Prognostic significance of histopathological tumor regression after neoadjuvant chemotherapy in esophageal adenocarcinomas.

Langer, R; Ott, K; Feith, M; Lordick, F; Siewert, JR; Becker, K

doi:10.1038/modpathol.2009.123

journal article

Title:: Prognostic significance of histopathological tumor regression after neoadjuvant chemotherapy in esophageal adenocarcinomas.
Document type:: Journal Article; Article
Author(s):: Langer, R; Ott, K; Feith, M; Lordick, F; Siewert, JR; Becker, K
Abstract:: We evaluated histomorphological findings in 92 surgical resection specimens of locally advanced esophageal adenocarcinomas after neoadjuvant cisplatin-based chemotherapy. Tumor response to neoadjuvant chemotherapy was determined using a system encompassing three tumor regression grades based on the estimation of the percentage of residual tumor tissue of the primary tumor site in relation to the macroscopically identifiable previous tumor bed. The significance of this system was validated by correlation of the tumor regression grades with the corresponding clinicopathological characteristics and patient survival. Seven patients (7%) had complete tumor regression (grade tumor regression grade 1), 48 patients (52%) had subtotal or partial tumor regression (tumor regression grade 2: 1-50% residual tumor), and 37 patients (40%) had minimal or no regression (tumor regression grade 3: >50% residual tumor). Tumor regression was significantly associated with posttreatment complete tumor resection status (UICC R0 status; P=0.016), tumor category (UICC pT category; P<0.001), and with the absence of either lymph node metastases (P=0.001) or lymphatic invasion (P<0.001). Survival analysis showed a significant prognostic relevance of the applied regression system in univariate (P<0.001) and multivariate analyses as a single independent factor (P=0.024). We conclude that the effect of preoperative chemotherapy in esophageal adenocarcinomas can be assessed by the determination of histological tumor regression, providing highly valuable prognostic information, which may even exceed the prognostic impact of the current TNM classification of these tumors. Therefore, we strongly recommend the implementation of a standardized tumor regression grading system in pathological reports of esophageal adenocarcinomas treated by neoadjuvant chemotherapy.
Journal title abbreviation:: Mod Pathol
Year:: 2009
Journal volume:: 22
Journal issue:: 12
Pages contribution:: 1555-63
Language:: eng
Fulltext / DOI:: doi:10.1038/modpathol.2009.123
Pubmed ID:: http://view.ncbi.nlm.nih.gov/pubmed/19801967
Print-ISSN:: 0893-3952
TUM Institution:: Chirurgische Klinik und Poliklinik; Institut für Allgemeine Pathologie und Pathologische Anatomie
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