{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T15:03:45Z","timestamp":1753887825392,"version":"3.41.2"},"reference-count":24,"publisher":"FapUNIFESP (SciELO)","license":[{"start":{"date-parts":[[2023,1,1]],"date-time":"2023-01-01T00:00:00Z","timestamp":1672531200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2023,1,1]],"date-time":"2023-01-01T00:00:00Z","timestamp":1672531200000},"content-version":"am","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2023,1,1]],"date-time":"2023-01-01T00:00:00Z","timestamp":1672531200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["ABCD, arq. bras. cir. dig."],"abstract":"<jats:p>ABSTRACT  BACKGROUND: The effect of neoadjuvant chemoradiotherapy (nCRT) in patients with locally advanced esophageal cancer can be determined by assessing the Becker tumor regression grade in the primary tumor, as well as in lymph nodes.  AIMS: The aim of this study was to investigate the anatomopathological changes caused by neoadjuvant chemoradiotherapy and their impact on clinical parameters. Specifically, we analyzed the Becker tumor regression grade, lymph node status, and regression changes and evaluated their association with the Clavien-Dindo classification of surgical complications and overall patient survival.  METHODS: This is a retrospective and observational study including 139 patients diagnosed with adenocarcinoma or squamous cell carcinoma of the esophagus and treated with either neoadjuvant chemoradiotherapy followed by surgery or surgery alone. For the 94 patients who underwent neoadjuvant chemoradiotherapy, we evaluated tumor regression by Becker tumor regression grade in primary tumors. We also analyzed lymph node status and regression changes on lymph nodes with or without metastases. Overall survival analysis was performed using Kaplan-Meier curves.  RESULTS: Becker tumor regression grade is associated with lower lymphatic permeation (p&lt;0.01) and vascular invasion (p&lt;0.001), but not with lymph node regression rate (p=0.10). Clavien-Dindo classification was associated neither with lymph node regression rate (odds ratio=0.784, p=0.795) nor with tumor regression grade (p=0.68). Patients who presented with lymphatic permeation and vascular invasion had statistically significantly lower median survival (17 vs. 30 months, p=0.006 for lymphatic permeation, and 14 vs. 29 months, p=0.024 for vascular invasion).  CONCLUSION: In our series, we were unable to demonstrate an association between Becker tumor regression grade and lymph node regression rate with any postoperative complications. Patients with lower lymphatic permeation and vascular invasion have higher overall survival, correlating with a better response in the Becker tumor regression grade system.<\/jats:p>","DOI":"10.1590\/0102-672020230002e1724","type":"journal-article","created":{"date-parts":[[2023,5,5]],"date-time":"2023-05-05T11:42:32Z","timestamp":1683286952000},"source":"Crossref","is-referenced-by-count":0,"title":["DOES NEOADJUVANT CHEMORADIOTHERAPY FOR ESOPHAGEAL AND GASTROESOPHAGEAL JUNCTION CANCER PATIENTS AFFECT POSTOPERATIVE OUTCOMES? A STUDY USING THE BECKER TUMOR REGRESSION GRADE SYSTEM AND LYMPH NODE REGRESSION"],"prefix":"10.1590","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9587-6731","authenticated-orcid":false,"given":"Maria In\u00eas Vaz do","family":"Ros\u00e1rio","sequence":"first","affiliation":[{"name":"Universidade do Porto,  Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5994-6189","authenticated-orcid":false,"given":"Jos\u00e9 Pedro","family":"Barbosa","sequence":"additional","affiliation":[{"name":"Universidade do Porto,  Portugal; Universidade do Porto,  Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3377-0530","authenticated-orcid":false,"given":"Irene","family":"Gullo","sequence":"additional","affiliation":[{"name":"Universidade do Porto,  Portugal; Universidade do Porto,  Portugal; Centro Hospitalar Universit\u00e1rio de S\u00e3o Jo\u00e3o,  Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6005-5383","authenticated-orcid":false,"given":"Jos\u00e9","family":"Barbosa","sequence":"additional","affiliation":[{"name":"Universidade do Porto,  Portugal; Centro Hospitalar Universit\u00e1rio de S\u00e3o Jo\u00e3o,  Portugal"}]}],"member":"530","published-online":{"date-parts":[[2023]]},"reference":[{"issue":"3","key":"ref1","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1016\/j.gtc.2016.04.001","article-title":"Esophageal Cancer","volume":"45","author":"Alsop BR","year":"2016","journal-title":"Gastroenterol Clin North Am"},{"issue":"3","key":"ref2","doi-asserted-by":"crossref","first-page":"e1621","DOI":"10.1590\/0102-672020210002e1621","article-title":"Neoadjuvant chemoradiotherapy followed by transhital esophagectomy in locally advanced esophageal squamous cell carcinoma: impact of pathological complete response","volume":"34","author":"Alves IPF","year":"2022","journal-title":"Arq Bras Cir Dig"},{"issue":"1","key":"ref3","doi-asserted-by":"crossref","first-page":"335.e15","DOI":"10.1053\/j.gastro.2020.02.068","article-title":"Global burden of 5 major types of gastrointestinal cancer","volume":"159","author":"Arnold M","year":"2020","journal-title":"Gastroenterology"},{"issue":"7","key":"ref4","doi-asserted-by":"crossref","first-page":"1521","DOI":"10.1002\/cncr.11660","article-title":"Histomorphology and grading of regression in gastric carcinoma treated with neoadjuvant chemotherapy","volume":"98","author":"Becker K","year":"2003","journal-title":"Cancer"},{"issue":"9","key":"ref5","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1016\/S1470-2045(05)70288-6","article-title":"Surgery alone versus chemoradiotherapy followed by surgery for resectable cancer of the oesophagus: a randomised controlled phase III trial","volume":"6","author":"Burmeister BH","year":"2005","journal-title":"Lancet Oncol"},{"issue":"7","key":"ref6","doi-asserted-by":"crossref","first-page":"1347","DOI":"10.1002\/cncr.20916","article-title":"Posttherapy pathologic stage predicts survival in patients with esophageal carcinoma receiving preoperative chemoradiation","volume":"103","author":"Chirieac LR","year":"2005","journal-title":"Cancer"},{"issue":"12","key":"ref7","doi-asserted-by":"crossref","first-page":"256","DOI":"10.21037\/atm.2019.05.23","article-title":"Prognostic value of lymphovascular invasion in patients with esophageal squamous cell carcinoma","volume":"7","author":"Gu YM","year":"2019","journal-title":"Ann Transl Med"},{"issue":"4","key":"ref8","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1111\/dote.12207","article-title":"Effects of neoadjuvant chemoradiotherapy on postoperative morbidity and mortality associated with esophageal cancer","volume":"28","author":"Hamai Y","year":"2015","journal-title":"Dis Esophagus"},{"issue":"3","key":"ref9","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1016\/j.asjsur.2016.10.005","article-title":"Esophageal cancer: Risk factors, genetic association, and treatment","volume":"41","author":"Huang FL","year":"2018","journal-title":"Asian J Surg"},{"issue":"20","key":"ref10","doi-asserted-by":"crossref","first-page":"2413","DOI":"10.2217\/fon-2019-0024","article-title":"Comparison of neoadjuvant chemoradiotherapy and neoadjuvant chemotherapy for esophageal cancer: a meta-analysis","volume":"15","author":"Jing SW","year":"2019","journal-title":"Future Oncol"},{"issue":"12","key":"ref11","doi-asserted-by":"crossref","first-page":"1555","DOI":"10.1038\/modpathol.2009.123","article-title":"Prognostic significance of histopathological tumor regression after neoadjuvant chemotherapy in esophageal adenocarcinomas","volume":"22","author":"Langer R","year":"2009","journal-title":"Mod Pathol"},{"issue":"6","key":"ref12","doi-asserted-by":"crossref","first-page":"e1022","DOI":"10.1097\/SLA.0000000000003727","article-title":"Prognostic impact of postoperative lymph node metastases after neoadjuvant chemoradiotherapy for locally advanced squamous cell carcinoma of esophagus: from the results of NEOCRTEC5010, a randomized multicenter study","volume":"274","author":"Leng X","year":"2021","journal-title":"Ann Surg"},{"key":"ref13","doi-asserted-by":"crossref","first-page":"v50","DOI":"10.1093\/annonc\/mdw329","article-title":"ESMO Guidelines Committee. Oesophageal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up","volume":"27","author":"Lordick F","year":"2016","journal-title":"Ann Oncol"},{"key":"ref14","doi-asserted-by":"crossref","first-page":"e1704","DOI":"10.1590\/0102-672020220002e1704","article-title":"Morbidity and survival after periooperative chemotherapy in gastric cancer: a study using the Becker's classification and lymphonodonal regression","volume":"35","author":"Machado MCA","year":"2023","journal-title":"Arq Bras Cir Dig"},{"issue":"5","key":"ref15","doi-asserted-by":"crossref","first-page":"570","DOI":"10.1016\/j.surg.2006.11.007","article-title":"The effect of neoadjuvant chemotherapy on lymph node micrometastases in squamous cell carcinomas of the thoracic esophagus","volume":"141","author":"Matsuyama J","year":"2007","journal-title":"Surgery"},{"issue":"9864","key":"ref16","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1016\/S0140-6736(12)60643-6","article-title":"Oesophageal carcinoma","volume":"381","author":"Pennathur A","year":"2013","journal-title":"Lancet"},{"issue":"2","key":"ref17","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1053\/j.semtcvs.2016.04.003","article-title":"Prognostic relevance of lymph node regression after neoadjuvant chemoradiation for esophageal cancer","volume":"28","author":"Philippron A","year":"2016","journal-title":"Semin Thorac Cardiovasc Surg"},{"issue":"1","key":"ref18","first-page":"22","article-title":"Esophageal cancer","volume":"95","author":"Short MW","year":"2017","journal-title":"Am Fam Physician"},{"issue":"11","key":"ref19","doi-asserted-by":"crossref","first-page":"1457","DOI":"10.1046\/j.1365-2168.1998.00940.x","article-title":"Classification of adenocarcinoma of the oesophagogastric junction","volume":"85","author":"Siewert JR","year":"1998","journal-title":"Br J Surg"},{"issue":"2","key":"ref20","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1002\/bjs.5983","article-title":"Effect of neoadjuvant chemotherapy on circumferential margin positivity and its impact on prognosis in patients with resectable oesophageal cancer","volume":"95","author":"Sujendran V","year":"2008","journal-title":"Br J Surg"},{"issue":"3","key":"ref21","doi-asserted-by":"crossref","first-page":"209","DOI":"10.3322\/caac.21660","article-title":"Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"71","author":"Sung H","year":"2021","journal-title":"CA Cancer J Clin"},{"key":"ref22","doi-asserted-by":"crossref","first-page":"262","DOI":"10.3389\/fonc.2013.00262","article-title":"Tumor regression grading of gastrointestinal carcinomas after neoadjuvant treatment","volume":"3","author":"Thies S","year":"2013","journal-title":"Front Oncol"},{"issue":"22","key":"ref23","doi-asserted-by":"crossref","first-page":"2074","DOI":"10.1056\/NEJMoa1112088","article-title":"Preoperative chemoradiotherapy for esophageal or junctional cancer","volume":"366","author":"van Hagen P","year":"2012","journal-title":"N Engl J Med"},{"issue":"2","key":"ref24","doi-asserted-by":"crossref","DOI":"10.1093\/dote\/doy083","article-title":"Lymphovascular invasion as a poor prognostic indicator in thoracic esophageal carcinoma: a systematic review and meta-analysis","volume":"32","author":"Wang A","year":"2019","journal-title":"Dis Esophagus"}],"container-title":["ABCD. Arquivos Brasileiros de Cirurgia Digestiva (S\u00e3o Paulo)"],"original-title":["A RADIOTERAPIA E QUIMIOTERAPIA NEOADJUVANTES PARA PACIENTES COM C\u00c2NCER DE ES\u00d4FAGO E JUN\u00c7\u00c3O GASTRO-ESOF\u00c1GICA AFETAM OS RESULTADOS P\u00d3S-OPERAT\u00d3RIOS? UM ESTUDO USANDO O SISTEMA DE REGRESS\u00c3O TUMORAL DE BECKER E REGRESS\u00c3O DE LINFONODOS"],"link":[{"URL":"http:\/\/www.scielo.br\/scielo.php?script=sci_pdf&pid=S0102-67202023000100305&tlng=en","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,5,5]],"date-time":"2023-05-05T11:42:55Z","timestamp":1683286975000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.scielo.br\/scielo.php?script=sci_arttext&pid=S0102-67202023000100305&tlng=en"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023]]},"references-count":24,"alternative-id":["S0102-67202023000100305"],"URL":"https:\/\/doi.org\/10.1590\/0102-672020230002e1724","relation":{},"ISSN":["2317-6326","0102-6720"],"issn-type":[{"type":"electronic","value":"2317-6326"},{"type":"print","value":"0102-6720"}],"subject":[],"published":{"date-parts":[[2023]]},"article-number":"e1724"}}