American Joint Committee on Cancer and College of American Pathologists Regression Grade

Mace, Adam G.; Pai, Rish K.; Stocchi, Luca; Kalady, Matthew F.

doi:10.1097/dcr.0000000000000266

Cited by 139 publications

(113 citation statements)

References 21 publications

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“…The AJCC/ CAP has recently proposed to use a three-tiered system based on Ryan et al original work (4). A recent report by Mace et al has definitively settled the prognostic influence of regression grade after CRT for rectal carcinoma in a large series of 538 patients (5). In this report, they have shown that regression is significantly associated to OS and also to local and distant recurrences.…”

Section: Discussionmentioning

confidence: 58%

“…However, there is still discussion regarding the need to employ adjuvant therapy, so there has been much interest in determining prognostic factors that influence outcome of patients after CRT. Many systems to grade regression have been proposed and validated in different studies, but in recent years it has become clear that three tiered systems are more reproducible and give the same prognostic information as five-tiered ones (3)(4)(5). The AJCC/ CAP has recently proposed to use a three-tiered system based on Ryan et al original work (4).…”

Section: Discussionmentioning

confidence: 99%

“…Initially most systems included five categories (3), but subsequent analysis concluded that threetiered systems could correlate better with prognosis (4). The American Joint Committee on Cancer/College of American Pathologists (AJCC/CAP) recommended in 2010 to use a three tiered-system that considers the relative proportion of fibrosis and viable tumor cells, as proposed by Ryan et al (4,5). Many authors have analyzed the prognostic significance of the different pathologic response grading systems with varying results (6,7), but very few studies have compared the different response patterns found in the tumor.…”

Section: Original Articlementioning

confidence: 99%

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Prognostic influence of histopathological regression patterns in rectal adenocarcinoma receiving neoadjuvant therapy

Fernández-Aceñero¹,

Muñoz²,

Varela³

et al. 2017

J. Gastrointest. Oncol.

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Results: A total of 183 patients from two hospitals. The concordance rate between pathologists was good. In total, 18% of the patients showed grade 0 (complete response), 31.7% grade 1, 19.2% grade 2 and 31.1% grade 3 regression. T down-staging was found in 51.9% of the cases. 46 patients recurred and 18 died of disease (median follow-up time: 39 months). We found a statistically significant association between pathological response and pT stage and down-staging. Inflammatory reaction in the tumor bed was significantly associated to regression and prognosis. Cox's multivariate analysis of survival revealed that down-staging and presence of mucin pools in the tumor bed behaved as significant predictors of recurrence and regression grade and mucin pools as significant predictors of survival.Conclusions: Pathological response is an important surrogate marker of prognosis in some large series, but results are varying. There are many systems to grade regression and this makes it difficult to compare the results by different groups. It is important to report the specific pattern of response, for some of them may have prognostic relevance. We feel there is an urgent need to develop standarized protocols and employ a universal regression scheme if we intend to use this factor to guide therapy.

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Section: Discussionmentioning

confidence: 58%

Section: Discussionmentioning

confidence: 99%

Section: Original Articlementioning

confidence: 99%

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Prognostic influence of histopathological regression patterns in rectal adenocarcinoma receiving neoadjuvant therapy

Fernández-Aceñero¹,

Muñoz²,

Varela³

et al. 2017

J. Gastrointest. Oncol.

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“…In addition, tumor regression grade (TRG) is a pathologic feature that should be reviewed in future studies and evaluated as a prognostic factor for outcomes, as it has received recent attention as a prognostic factor in LARC treated with nCRT. 34 Unfortunately, as TRG was added to the rectal cancer reporting criteria in the AJCC 7th edition (2010), and most of our patients were treated before 2010, we did not have sufficient cases to evaluate the prognostic impact of TRG. Finally, the 20 patients with pCR were not included in this study as our intention was to focus more directly on the prognostic impact of PNI on patients with residual tumor at the time of surgery.…”

Section: Discussionmentioning

confidence: 99%

Perineural Invasion Predicts for Distant Metastasis in Locally Advanced Rectal Cancer Treated With Neoadjuvant Chemoradiation and Surgery

Chablani¹,

Nguyen²,

Pan³

et al. 2017

American Journal of Clinical Oncology

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Objectives The benefit of adjuvant chemotherapy in patients with locally advanced rectal cancer (LARC) treated with neoadjuvant chemoradiotherapy (nCRT) and surgery is controversial. We examined the association of perineural invasion (PNI) with outcomes to determine whether PNI could be used to risk-stratify patients. Materials and Methods We performed a retrospective study of 110 patients treated with nCRT and surgery for LARC at our institution from 2004 to 2011. Eighty-seven patients were identified in our final analysis. We evaluated the association of PNI with locoregional control, distant metastasis-free survival (DMFS), disease-free survival (DFS), and overall survival, using log-rank and Cox proportional hazard modeling. Results Fourteen patients (16%) were PNI + and 73 patients (84%) were PNI−. The median follow-up was 27 months (range, 0.9 to 84 mo). The median DMFS was 13.5 months for PNI + and median not reached (> 40 mo) for PNI− (P < 0.0001). The median DFS was 13.5 months for PNI + and 39.8 months for PNI− (P < 0.0001). In a multivariate model including 7 pathologic variables, type of surgery, time to surgery from end of nCRT, and use of adjuvant chemotherapy, PNI remained a significant independent predictor of DMFS (hazard ratio 9.79; 95% confidence interval, 3.48–27.53; P < 0.0001) and DFS (hazard ratio 5.72; 95% confidence interval, 2.2–14.9; P = 0.0001). Conclusions For patients with LARC treated with nCRT, PNI found at the time of surgery is significantly associated with worse DMFS and DFS. Our data support testing the role of adjuvant chemotherapy in patients with PNI and perhaps other high-risk features.

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“…The pathologic tumor (T) and nodal (N) stages (ypT and ypN, respectively) of the tumor, histological grade, lymphovascular invasion, perineural invasion, tumor regression grade (TRG), and status of the circumferential, proximal, and distal resection margins were documented. The tumor response after CCRT was assessed according to the American Joint Committee on Cancer (AJCC) system as follows [18]: Grade 0, no residual cancer cells; Grade 1, single cell or small group of cancer cells (major regression); Grade 2, residual cancer with desmoplastic response (moderate regression); and Grade 3, minimal evidence of tumor response. A circumferential resection margin (CRM) of <1 mm was defined as an involved CRM [19].…”

Section: Methodsmentioning

confidence: 99%

Neoadjuvant FOLFOX chemotherapy combined with radiotherapy followed by radical resection in patients with locally advanced colon cancer

Huang

Yeh

et al. 2017

Radiat Oncol

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BackgroundPatients with locally advanced colon cancer (LACC) have a relatively poor prognosis despite radical resection and adjuvant chemotherapy. This study investigated the treatment efficacy and toxicity of neoadjuvant chemoradiotherapy in patients with LACC.MethodsWe retrospectively reviewed 36 patients with LACC preoperatively treated with chemotherapy and radiotherapy. Patients were administered chemoradiotherapy, which comprised radiotherapy and neoadjuvant chemotherapy involving a 5-fluorouracil, leucovorin, and oxaliplatin regimen every 2 weeks.ResultsMedian age was 64 years (45–86 years) and median follow-up period was 23.5 months (5.0–49.1 months). Seven (19.4%) patients developed grade 3 or 4 adverse events during neoadjuvant concurrent chemoradiotherapy. Pathologic responses were not evaluated in two patients who did not undergo radical resection. Of the 34 patients who underwent surgery, nine (26.4%) achieved a pathologic complete response (pCR). The 2-year estimated overall survival and disease-free survival rates were 88.7% and 73.6%, respectively.ConclusionsOur results demonstrated that neoadjuvant chemoradiotherapy is feasible and safe. A prominent pCR rate with an acceptable toxicity profile suggests that the multimodality therapy might be a treatment option for patients with LACC.

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American Joint Committee on Cancer and College of American Pathologists Regression Grade

Abstract: This is the first study to delineate American Joint Committee on Cancer/College of American Pathologists regression grade as an independent oncologic prognostic factor. This information can be used in discussions with patients who have rectal cancer.

Cited by 139 publications

References 21 publications

Prognostic influence of histopathological regression patterns in rectal adenocarcinoma receiving neoadjuvant therapy

Prognostic influence of histopathological regression patterns in rectal adenocarcinoma receiving neoadjuvant therapy

Perineural Invasion Predicts for Distant Metastasis in Locally Advanced Rectal Cancer Treated With Neoadjuvant Chemoradiation and Surgery

Neoadjuvant FOLFOX chemotherapy combined with radiotherapy followed by radical resection in patients with locally advanced colon cancer

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