title: Prognostic value of histopathological regression in 850 neoadjuvantly treated oesophagogastric adenocarcinomas.
abstract: BACKGROUND
  Recently, histopathological tumour regression, prevalence of signet ring cells, and localisation were reported as prognostic factors in neoadjuvantly treated oesophagogastric (junctional and gastric) cancer. This exploratory retrospective study analyses independent prognostic factors within a large patient cohort after preoperative chemotherapy including clinical and histopathological factors.
  
  
  METHODS
  In all, 850 patients presenting with oesophagogastric cancer staged cT3/4 Nany cM0/x were treated with neoadjuvant chemotherapy followed by resection in two academic centres. Patient data were documented in a prospective database and retrospectively analysed.
  
  
  RESULTS
  Of all factors prognostic on univariate analysis, only clinical response, complications, ypTNM stage, and R category were independently prognostic (P<0.01) on multivariate analysis. Tumour localisation and signet ring cells were independently prognostic only when investigator-dependent clinical response evaluation was excluded from the multivariate model. Histopathological tumour regression correlates with tumour grading, Laurén classification, clinical response, ypT, ypN, and R categories but was not identified as an independent prognostic factor. Within R0-resected patients only surgical complications and ypTNM stage were independent prognostic factors.
  
  
  CONCLUSIONS
  Only established prognostic factors like ypTNM stage, R category, and complications were identified as independent prognostic factors in resected patients after neoadjuvant chemotherapy. In contrast, histopathological tumour regression was not found as an independent prognostic marker.
authors.affiliation: Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Schmidt
authors.affiliation: Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany.
authors.forename: L
authors.initials: L
authors.lastname: Sicic
authors.affiliation: Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Blank
authors.affiliation: Department of Pathology, Technische Universitaet Muenchen, 81675 Munich, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Becker
authors.affiliation: Department of Pathology, University of Heidelberg, 69120 Heidelberg, Germany.
authors.forename: W
authors.initials: W
authors.lastname: Weichert
authors.affiliation: Institute of Medical Biometry and Informatics (IMBI), University of Heidelberg, 69120 Heidelberg, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Bruckner
authors.affiliation: Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Parakonthun
authors.affiliation: Department of Pathology, University of Bern, 3010 Bern, Switzerland.
authors.forename: R
authors.initials: R
authors.lastname: Langer
authors.affiliation: Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany.
authors.forename: M W
authors.initials: MW
authors.lastname: Büchler
authors.affiliation: Directorate, University of Freiburg, 79095 Freiburg, Germany.
authors.forename: J-R
authors.initials: JR
authors.lastname: Siewert
authors.affiliation: University Cancer Center Leipzig (UCCL), University of Leipzig, 04103 Leipzig, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Lordick
authors.affiliation: Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Ott
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology* / Q000628:therapy*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004938:Esophageal Neoplasms / Q000473:pathology* / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011379:Prognosis; D012074:Remission Induction; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000473:pathology* / Q000628:therapy*; D047368:Tumor Burden; D055815:Young Adult