ORIGINAL ARTICLE Factors predicting prognosis and recurrence in patients with esophago-gastric adenocarcinoma and histopathological response with less than 10 % residual tumor Katja Ott & Susanne Blank & Karen Becker & Rupert Langer & Wilko Weichert & Wilfried Roth & Leila Sisic & Annika Stange & Dirk Jäger & Markus Büchler & Jörg-Rüdiger Siewert & Florian Lordick Received: 11 October 2012 / Accepted: 5 December 2012 / Published online: 27 December 2012 # Springer-Verlag Berlin Heidelberg 2012 Abstract Purpose Neoadjuvant treatment is an accepted standard ap- proach for treating locally advanced esophago-gastric adenocarcinomas. Despite a response of the primary tumor, a significant percentage dies from tumor recurrence. The aim of this retrospective exploratory study from two aca- demic centers was to identify predictors of survival and recurrence in histopathologically responding patients. Methods Two hundred thirty one patients with adenocarcino- mas (esophagus: n 0 185, stomach: n 0 46, cT3/4, cN0/+, cM0) treated with preoperative chemotherapy (n 0 212) or chemo- radiotherapy (n 0 19) followed by resection achieved a histopathological response (regression 1a: no residual tumor (n 0 58), and regression 1b<10 % residual tumor (n 0 173)). Results The estimated median overall survival was 92.4 months (5-year survival, 56.6 %) for all patients. For patients with regression 1a, median survival is not reached (5-year survival, 71.6 %) compared to patients with regres- sion 1b with 75.3 months median (5-year survival, 52.2 %) (p 0 0.031). Patients with a regression 1a had lymph node metastases in 19.0 versus 33.7 % in regression 1b. The ypT- category (p <0.001), the M-category (p 0 0.005), and the type of treatment (p 0 0.04) were found to be independent prognostic factors in R0-resected patients. The recurrence rate was 31.7 % (n 0 66) (local, 39.4 %; peritoneal carcino- matosis, 25.7 %; distant metastases, 50 %). Recurrence was predicted by female gender (p 0 0.013), ypT-category (p 0 0.007), and M-category (p 0 0.003) in multivariate analysis. Conclusion Response of the primary tumor does not guaran- tee recurrence-free long-term survival, but histopathological complete responders have better prognosis compared to par- tial responders. Established prognostic factors strongly influ- ence the outcome, which could, in the future, be used for stratification of adjuvant treatment approaches. Increasing the rate of histopathological complete responders is a valid endpoint for future clinical trials investigating new drugs. Keywords Histopathological response . Esophago-gastric adenocarcinoma . Prognostic factors . Patterns of recurrence Introduction Pre- or perioperative treatment is nowadays a standard for locally advanced adenocarcinomas of the esophagus or Ott Katja and Blank Susanne contributed equally to this work. K. Ott (*) : S. Blank : L. Sisic : M. Büchler Department of Surgery, University Hospital of Heidelberg, Heidelberg, Germany e-mail: katja.ott@med.uni-heidelberg.de K. Becker : R. Langer Institute of Pathology, Technical University, Munich, Germany W. Weichert : W. Roth Institute of Pathology, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany A. Stange : D. Jäger National Center of Tumor Diseases, University of Heidelberg, Heidelberg, Germany J.-R. Siewert Directorate, University of Freiburg, Freiburg, Germany F. Lordick University Cancer Center Leipzig (UCCL), University Clinic Leipzig, Leipzig, Germany Langenbecks Arch Surg (2013) 398:239–249 DOI 10.1007/s00423-012-1039-0