Complete histopathologic tumor regression after neoadjuvant treatment is a well-known prognostic factor for survival among patients with adenocarcinomas of the esophagus and gastroesophageal junction. The aim of this international Delphi survey was to reach a consensus regarding the most useful tumor regression grading (TRG) system that could represent an international standard for histopathologic TRG grading of gastroesophageal carcinomas. Fifteen pathologists with special interest in esophageal and gastric pathology participated in the online survey. The initial questionnaire contained of 43 statements that addressed the following topics: (1) specimen processing, (2) gross examination, (3) cross sectioning, (4) staining, (5) Barrett's esophagus, (6) TRG systems, and (7) TRG in lymph node (LN). Participants rated the items using a 5-point Likert style scale and were encouraged to write comments for each statement. The expert panel recommended a 4-tiered TRG system for assessing the primary tumor: grade 1: No residual tumor (complete histopathologic tumor regression), grade 2: less than 10% residual tumor (near-complete regression), grade 3: 10%-50% residual tumor (partial regression), grade 4: greater than 50% residual tumor (minimal/no regression), combined with a 3-tiered system for grading therapeutic response in metastatic LNs: grade a: no residual tumor (complete histopathologic TRG), grade b: partial regression (tumor cells and regression), grade c: no regression (no sign of tumor response). This TRG grading system can be recommended as an international standard for histopathologic TRG grading in esophageal and gastroesophageal junction adenocarcinoma.

Centro Hospitalar Universitário de São João 4200 319 Porto Portugal

Department of Clinical Pathology Karolinska University Hospital Huddinge 141 86 Stockolm Sweden

Department of Laboratory Medicine and Pathobiology Mount Sinai Hospital University of Toronto M5G 1X5 Toronto Canada

Department of Pathology Amsterdam University Medical Centers Location AMC 1081 HV Amsterdam the Netherlands

Department of Pathology and Laboratory Medicine Weill Cornell Medicine 10065 New York NY USA

Department of Pathology Carmel Medical Center 3436212 Haifa Israel

Department of Pathology Odense University Hospital Denmark and Dept of Clinical Research Faculty of Health Sciences University of Southern Denmark 5000 Odense Denmark

Department of Pathology Saint Antoine Hospital Pierre et Marie Curie University 75571 Paris France

Department of Pathology St Vincent's University Hospital and UCD School of Medicine Dublin D04 T6F4 Ireland

Department of Pathology Virginia Mason Medical Center 98101 Seattle WA USA

Department of Thoracic Surgery Virginia Mason Medical Center Seattle WA USA

Department of Upper Abdominal Surgery Division of Surgery Department of Clinical Science Intervention and Technology Karolinska University Hospital Karolinska Institutet 141 57 Huddinge Stockholm Sweden

Department of Upper Abdominal Surgery Division of Surgery Department of Clinical Science Intervention and Technology Karolinska University Hospital Karolinska Institutet 141 57 Huddinge Stockholm Sweden; Department of Surgery Odense University Hospital 5000 Odense Denmark

Division of Anatomic Pathology Department of Surgical Science and Integrated Diagnostics University of Genoa and Ospedale Policlinico IRCCS San Martino 16126 Genoa Italy

Institute of Pathology Klinikum Bayreuth 95445 Bayreuth Germany

The Fingerland Department of Pathology Charles University Faculty of Medicine and University Hospital Hradec Králové Hradec Králové 500 03 Czech Republic

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