title: Neoadjuvant chemoradiation treatment followed by surgery for esophageal cancer: there is much more than the mandard tumor regression score.
abstract: OBJECTIVE
  Tumor regression grading (TRG) systems categorize residual tumor volume on the primary tumor after neoadjuvant treatment. Aim was to evaluate the impact of Mandard TRG, residual tumor depth (ypT) and residual lymph node status (ypN) and extent (ELNI) i.e. intracapsular versus extracapsular involvement on overall (OS) and disease-free survival (DFS) in esophageal carcinoma.
  
  
  METHODS
  Between 2005 and 2014, 344 patients receiving R0-esophagectomy after neoadjuvant chemoradiation therapy (nCRT) were selected. Mandard TRG, ypTN and ELNI were prospectively recorded.
  
  
  RESULTS
  Mandard TRG1 was found in 110 (32%); TRG2 in 120 (35%); TRG3 in 53 (15%); TRG4 in 54 (16%) and TRG5 in 7 (2%) patients. Both OS and DFS showed no significant difference between TRG1 and 2 (p = 0.059 and 0.105, respectively). Therefore, TRG1/2 was classified together as 'major response', TRG3/4 as 'minor response' and TRG5 as 'no response'. Multivariate analysis showed two independent prognosticators for OS (tumor regression response (TRR) and number of positive lymph nodes) and three independent prognosticators for DFS (TRR, ypT and ELNI).
  
  
  CONCLUSIONS
  After nCRT followed by surgery for esophageal carcinoma, number of residual positive lymph nodes as well as TRR are prognosticators for OS. Minor TRR, ypT and extracapsular lymph node invasion are prognosticators for recurrence.
authors.affiliation: a Department of Thoracic Surgery , UZ Leuven Gasthuisberg , Leuven , Belgium.
authors.forename: L
authors.initials: L
authors.lastname: Depypere
authors.affiliation: a Department of Thoracic Surgery , UZ Leuven Gasthuisberg , Leuven , Belgium.
authors.forename: J
authors.initials: J
authors.lastname: Moons
authors.affiliation: a Department of Thoracic Surgery , UZ Leuven Gasthuisberg , Leuven , Belgium.
authors.forename: T
authors.initials: T
authors.lastname: Lerut
authors.affiliation: b Department of Pathology , UZ Leuven Gasthuisberg , Leuven , Belgium.
authors.forename: G
authors.initials: G
authors.lastname: De Hertogh
authors.affiliation: b Department of Pathology , UZ Leuven Gasthuisberg , Leuven , Belgium.
authors.forename: X
authors.initials: X
authors.lastname: Sagaert
authors.affiliation: a Department of Thoracic Surgery , UZ Leuven Gasthuisberg , Leuven , Belgium.
authors.forename: W
authors.initials: W
authors.lastname: Coosemans
authors.affiliation: a Department of Thoracic Surgery , UZ Leuven Gasthuisberg , Leuven , Belgium.
authors.forename: H
authors.initials: H
authors.lastname: Van Veer
authors.affiliation: a Department of Thoracic Surgery , UZ Leuven Gasthuisberg , Leuven , Belgium.
authors.forename: A
authors.initials: A
authors.lastname: Renders
authors.affiliation: a Department of Thoracic Surgery , UZ Leuven Gasthuisberg , Leuven , Belgium.
authors.forename: P
authors.initials: P
authors.lastname: Nafteux
keywords: Chemoradiotherapy; esophageal neoplasm; neoadjuvant therapy; surgical pathology