An investigation into tumor regression grade as a parameter for locally advanced rectal cancer and 5-year overall survival rate

Abstract

Purpose: The standard treatment for locally advanced rectal cancer (LARC) is neoadjuvant chemoradiation (nCRT) followed by surgery. Several parameters are associated with patient survival in LARC. One of these parameters is tumor regression grade (TRG); however, the significance of TRG remains controversial. In this study, we aimed to examine the correlations of TRG with 5-year overall (OS) and relapse-free survival (RFS) and identify other factors that influence the survival rates in LARC after nCRT followed by surgery.Methods: This retrospective study included 104 patients diagnosed with LARC who underwent nCRT followed by surgery at Songklanagarind Hospital from January 2010 to December 2015. All patients received fluoropyrimidine-based chemotherapy at a total dose of 45.0 to 50.4 Gy in 25 daily fractions. Tumor response was evaluated using the 5-tier Mandard TRG classification. TRG was categorized into good (TRG 1–2) and poor (TRG 3–5) responses.Results: TRG (classified by either the 5-tier classification system or the 2-group classification system) was not correlated with 5-year OS or RFS. The 5-year OS rates were 80.0%, 54.5%, 80.8%, and 67.4% in patients with TRG 1, 2, 3, and 4, respectively (P=0.22). Poorly differentiated rectal cancer and systemic metastasis were associated with poor 5-year OS. Intraoperative tumor perforation, poor differentiation, and perineural invasion were correlated with inferior 5-year RFS.Conclusion: TRG was probably not associated with either 5-year OS or RFS; however, poor differentiation and systemic metastasis were strongly associated with poor 5-year OS.

Risk-factors for locally advanced rectal cancer relapse after neoadjuvant chemoradiotherapy: A single center experience

“…[ 47 ] Finally, Laohawiriyakamol et al found that the intraoperative perforation was associated with inferior 5-year relapse-free survival. [ 49 ] Combined with our findings, these results highlight the importance of adverse events in rectal cancer surgery. There is an urge for further study for optimal definitions of surgical adverse effects, as well as its impact on the recurrence and survival of LARC patients during the ongoing TME era.…”

Performance reporting design in artificial intelligence studies using image-based TNM staging and prognostic parameters in rectal cancer: a systematic review

“…In patients with advanced rectal cancer, if there is a good response to treatment after preoperative chemoradiotherapy (CRT), local excision or a nonoperative management, also known as the “watch-and-wait” strategy, may be attempted [ 10 , 11 ]. It is important to select the appropriate candidate for tailored treatment in rectal cancer, which requires accurate diagnosis and assessment of response to preoperative treatment [ 12 , 13 ].…”