Esophageal Adenocarcinoma Methods and Protocols

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Tumor regression grade and lymph node downstaging after

neoadjuvant therapy for esophageal adenocarcinoma are associ-

ated with improved disease-free survival of the patients [ 25 ].

The most common method to assess the tumor regression

grade is Mandard classification system [ 24 ]. The 5-tiered sys-

tem divided the tumor regression into five grade based on the

proportion of viable tumor tissues in relationship to fibrosis.

Grade 1 is complete regression (fibrosis without carcinoma);

grade 2 is fibrosis with scattered tumor cells; grade 3 is fibrosis

more than tumor cells; grade 4 is tumor cells more than fibro-

sis; grade 5 is carcinoma without regression. There is also a

4-tiered system (Becker system) for assessment of the effect of

neoadjuvant therapy. The system depends on the proportion of

residual cancer cells [ 26 ]. In this system; 1a: 0% carcinoma; 1b:

<10% carcinoma; 2: 10–50% carcinoma; 3: >50% carcinoma.

References

Fig. 6 Post-neoadjuvant therapy effect: Changes in blood vessels and fibrosis in

the stroma

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Pathology of Esophageal Adenocarcinoma