Annals of Oncology Advance Access published online on October 3, 2008
Annals of Oncology, doi:10.1093/annonc/mdn622
Histological type of esophageal cancer might affect response to neo-adjuvant radiochemotherapy and subsequent prognosis
1 Department of General-, Visceral- and Cancer Surgery, University of Cologne
2 Institute of Pathology, University of Cologne, Cologne
3 Institute of Pathology, University of Düsseldorf, Düsseldorf
4 Department of Radiation Oncology, University of Cologne, Cologne, Germany
* Correspondence to: Prof. E. Bollschweiler, Klinik und Poliklinik für Allgemein-, Visceral- und Tumorchirurgie, der Universität zu Köln, Kerpener Str. 62, 50937 Köln, Germany. Tel: +49-221-478 6273; Fax: +49-221-478 5076; E-mail: elfriede.bollschweiler{at}uk-koeln.de
Background: This study investigates response and prognosis after neo-adjuvant chemoradiation (CTx/RTx) in patients with advanced esophageal carcinoma, according to histological type.
Patients and methods: Patients with uT3 carcinoma of the esophagus treated with curative-intention esophagectomy from 1997 until 2006 were included in this retrospective analysis. Patients receiving preoperative CTx/RTx (5-fluorouracil, cisplatin, 36 Gy) were compared with those with primary surgery for pT3 tumors. Therapy response after CTx/RTx was evaluated using ‘Cologne Regression Grade’ (minor response: 
10% vital residual tumor cells (VRTCs), major response: <10% VRTC or pathologic complete response). Prognosis was evaluated for adenocarcinoma (AC) and squamous cell carcinoma (SCC).
Results: Of 297 patients, 52% were SCC and 48% AC. In all, 192 patients underwent CTx/RTx, 100 (65%) SCC and 92 (64%) AC (nonsignificant). In SCC group 51% and in AC group 29% achieved major response (P < 0.01). Patients with major response had a 2-year survival rate (2y-SR) of 78% versus those with minor response or without CTx/RTx, with a 2y-SR of 45% (P = 0.001). Examining patients with major response exclusively, the prognosis of AC (2y-SR 85%) is better than that of SCC (2y-SR 54%) (P < 0.01).
Conclusion: This retrospective study concludes that in esophageal tumors, response to and prognosis after neo-adjuvant CTx/RTx vary according to histology.
adenocarcinoma squamous cell carcinoma, esophageal cancer, lymph node metastases, neo-adjuvant chemoradiation, prognosis
Received for publication May 4, 2008. Revision received August 5, 2008. Accepted for publication August 6, 2008.