title: Impact of response evaluation for resectable esophageal adenocarcinoma - a retrospective cohort study.
abstract: BACKGROUND
  The standard treatment concept in patients with locally advanced adenocarcinoma of the esophagogastric junction is neoadjuvant chemotherapy, followed by tumor resection in curative intent. Response evaluation of neoadjuvant chemotherapy using histopathological tumor regression grade (TRG) has been shown to be a prognostic factor in patients with esophageal cancer.
  
  
  METHODS
  We assessed the impact of the various methods of response control and their value in correlation to established prognostic factors in a cohort of patients with adenocarcinoma at the gastroesophageal junction treated by neoadjuvant chemotherapy.
  
  
  RESULTS
  After neoadjuvant chemotherapy, in 56 consecutive patients with locally advanced (T2/3/4 and/or N0/N1) esophageal adenocarcinoma an oncologic tumor resection for curative intent was performed. Median follow-up was 44 months. Histopathological tumor stages were stage 0 in 10.7%, stage I in 17.9%, stage II in 21.4%, stage III in 41.1% and stage IV 8.9%. The 3-year overall survival (OS) rate was 30.3%. In univariate analysis, ypN-status, histopathological tumor stage and tumor regression grade correlated significantly with overall survival (p = 0.022, p = 0.001, p = 0.035 respectively). Clinical response evaluation could not predict response and overall survival (p = 0.556, p = 0.254 respectively).
  
  
  CONCLUSIONS
  After preoperative chemotherapy, outcomes of esophageal carcinoma are best predicted utilizing pathological tumor stage and histologic tumor regression. Clinical response assessments were not useful for guidance of treatment.
authors.affiliation: Department of General, Visceral and Transplantation Surgery, University of Tübingen, Hoppe-Seyler Str. 3, 72076 Tübingen, Germany. Electronic address: robert.bachmann@med.uni-tuebingen.de.
authors.forename: R
authors.initials: R
authors.lastname: Bachmann
authors.affiliation: Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Bachmann
authors.affiliation: Department of General, Visceral and Transplantation Surgery, University of Tübingen, Hoppe-Seyler Str. 3, 72076 Tübingen, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Hungbauer
authors.affiliation: Department of Radiology, University of Tübingen, Hoppe-Seyler Str. 3, 72076 Tübingen, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Schmehl
authors.affiliation: Department of General, Visceral and Transplantation Surgery, University of Tübingen, Hoppe-Seyler Str. 3, 72076 Tübingen, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Sitzmann
authors.affiliation: Department of General, Visceral and Transplantation Surgery, University of Tübingen, Hoppe-Seyler Str. 3, 72076 Tübingen, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Königsrainer
authors.affiliation: Department of General, Visceral and Transplantation Surgery, University of Tübingen, Hoppe-Seyler Str. 3, 72076 Tübingen, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Ladurner
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D000368:Aged; D000714:Anastomosis, Surgical; D017024:Chemotherapy, Adjuvant; D015331:Cohort Studies; D004938:Esophageal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D016629:Esophagectomy; D004943:Esophagogastric Junction / Q000473:pathology* / Q000601:surgery; D005260:Female; D005743:Gastrectomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local; D011379:Prognosis; D012189:Retrospective Studies
keywords: Esophageal carcinoma; Histopathological regression grading; Neoadjuvant chemotherapy; Prognostic factors