Histomorphologic tumor regression and lymph node status (ypN) were significant prognostic parameters for patients with complete resections (R0) following neoadjuvant radiochemotherapy for esophageal cancer. A regression classification based on 2 parameters could lead to improved objective evaluation of the effectiveness of treatment protocols, accuracy of staging and restaging modalities, and molecular response prediction.

BACKGROUND The rise in adenocarcinoma (AC) of the esophagus has been reported in several papers. However, the results are only comparable to a limited extent, because they are based on differing periods and different computational methods. The purpose of the current investigation was to collect the available data and to analyze them in a unified manner. METHODS The authors requested data on the incidence of AC of the esophagus for each year since 1960 from 43 tumor registries in North America, Europe, and Australia. The data from 22 centers were used. The trend was calculated by fitting the data to an exponential growth model. RESULTS The incidence of AC of the esophagus in white males is rising in most countries. The highest values of the estimated incidence rate in the year 2000 were found in Great Britain (5.0– 8.7 cases per 100,000 population) and in Australia (4.8 cases per 100,000 population) followed by The Netherlands (4.4 cases per 100,000 population), the United States (3.7 cases per 100,000 population), and Denmark (2.8 cases per 100,000 population). Low rates (< 1.0 cases per 100,000 population) were found in Eastern Europe. The largest changes in incidence were reported in the Southern European countries, with an estimate of the average increase over six registries of 30% per year; in Australia, with an average increase of 23.5% per year; and in the United States, with an average increase of 20.6% per year. The rates of increase ranged from 8.7% to 17.5% on average in Northern Europe, Central Europe, and the United Kingdom. In Eastern Europe, at most, there was a minor rise in incidence. CONCLUSIONS In the Western industrialized nations, the analyzed data show that the incidence of AC of the esophagus has been rising rapidly in the last 20 years. The only exceptions to date are the countries of Eastern Europe. Cancer 2001;92:549–55. © 2001 American Cancer Society.

The most important factor for predicting lymph-node metastasis in early esophageal cancer is the presence of submucosal infiltration. Early adenocarcinomas and SCCs do not differ with regard to their rate of lymphatic involvement. The rate of lymph-node metastasis increases with the depth of submucosal infiltration, but metastases can already occur in sm1 lesions. Submucosal infiltration is a contraindication for endoscopic mucosectomy. Limited surgical procedures without adequate lymphadenectomy do not appear to be appropriate in the treatment of patients with submucosal esophageal carcinomas.

For patients with mucosal BC, both surgery and ER are effective treatment modalities. Surgery is associated with a higher morbidity rate and shows a risk for procedure-related mortality. However, the recurrence rate is higher in patients treated with ER, so that thorough follow-up procedures are mandatory.