Connection and distinction of tumor regression grading systems of gastrointestinal cancer

Tong, Yilin; Liu, Dong; Zhang, Jianjun

doi:10.1016/j.prp.2020.153073

Cited by 20 publications

(15 citation statements)

References 51 publications

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“…As previously highlighted by several authors, ypTNM stage takes a snapshot of post‐neoadjuvant tumor status but it does not give any information about tumor response to NACT, 37,38 resulting in a static, and probably not exhaustive, measure of disease assessment. In contrast, our study seems to suggest that TRG, representing a more “dynamic” measure of susceptibility to PC, could be more adequate to account for patients' prognosis.…”

Section: Discussionmentioning

confidence: 99%

Prognostic value of pathological tumor regression grade in locally advanced gastric cancer: New perspectives from a single‐center experience

Lombardi

Mazzola

Achilli

et al. 2021

Journal of Surgical Oncology

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Background and Objective Perioperative chemotherapy (PC) with radical surgery represents the gold standard of treatment for resectable advanced gastric cancer (GC). The prognostic value of pathological tumor regression grade (TRG) induced by neoadjuvant chemotherapy (NACT) is not clearly established. This study aimed to investigate the correlation between TRG and survival in GC. Methods Patients affected by advanced GC undergoing PC and radical surgery were considered. TRG was assessed for each patient according to Becker's grading system. The correlation between TRG and survival was investigated. Results One‐hundred patients were selected; 25 showed a good response (GR) (TRG 1a/1b), while 75 had a poor response (PR) (TRG 2/3) to NACT. GR patients showed better disease‐free survival (DFS) (52 vs. 19 months, p < .001) and disease‐specific survival (DSS) (57 vs. 25 months, p < .0001) when compared to PR patients. On univariate analysis, TRG, lymph node ratio (LNR), tumor size, grading, and post‐neoadjuvant therapy TNM stage were significantly correlated with survival. On multivariate analysis, TRG, LNR and tumor size were independent prognostic factors for DFS and DSS. Conclusions TRG, LNR, and tumor size are independent prognostic factors for DFS and DSS in patients with advanced GC undergoing NACT.

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Section: Discussionmentioning

confidence: 99%

Prognostic value of pathological tumor regression grade in locally advanced gastric cancer: New perspectives from a single‐center experience

Lombardi

Mazzola

Achilli

et al. 2021

Journal of Surgical Oncology

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“…Tumor regression grade is a widely used standard to evaluate the effectiveness, but there are many different versions. This study is based on CAP TRG, which is derived from Mandard TRG [9], but a little different [8]. Mandard TRG focuses on the relative relationship between residual tumor and fibrosis while CAP TRG merely concentrates on the amount of residual tumor.…”

Section: Discussionmentioning

confidence: 99%

“…The evaluation of the efficacy of NCT is becoming increasingly important. Pathologically, except for TNM stage, tumor regression grade (TRG) is widely used to assess the reaction of tumor [8].…”

Section: Introductionmentioning

confidence: 99%

CA724 Predicts Tumor Regression Grade in Locally Advanced Gastric Cancer Patients with Neoadjuvant Chemotherapy

et al. 2021

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Purpose: Tumor regression grade (TRG) is widely used to evaluate the efficacy of neoadjuvant chemotherapy (NCT) and it is related to many clinicopathological factors. However, whether TRG can be predicted by clinical characteristics is unknown. Methods: 141 locally advanced gastric cancer (GC) patients who underwent NCT and curative operation were retrospectively analyzed. TRG is reevaluated according to the CAP guideline. The values of CA199, CA125 and CA724 before NCT (pre-) and after NCT (post-) were extracted from our database. Survival curves on overall survival (OS) were obtained by Kaplan-Meier method, and differences were analyzed by log-rank test. Associations between categorical variables were explored by chi-square test or Fisher's exact method. Univariable and multivariate analyses were performed by logistic regression model or Cox proportional hazard regression model. Results: TRG was related to OS (P < 0.001), especially when divided into responders (TRG 0-1) and non-responders (TRG 2-3). Pre-CA724 (p = 0.029) and post-CA199 (p = 0.038) were related to OS. In multivariable analysis, pre-CA724 (p = 0.015) and post-CA199 (p = 0.007) were independent prognostic factors for OS, respectively. The changes (diff-) of all tumor markers were not related to OS. Among the clinical characteristics, pre-CA724 (P = 0.047) and tumor size (P = 0.012) were related to TRG, while pre-CA199 (P = 0.377) and pre-CA125 (P = 0.856) were not. In logistics analysis, pre-CA724 (P = 0.032), tumor size (P = 0.011) and tumor location (P = 0.047) were independent risk factors to pathological response. Conclusion: CA724 was an independent prognostic factor for OS and could be used to predict pathological response.

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“…Currently, most pathologists favor four-tier TRG systems in gastrointestinal cancer. There are the Becker system and the American Joint Committee on Cancer (AJCC)/ College of American Pathologists (CAP) system, as these have superior inter-rater agreement with no loss of discriminatory ability[ 4 , 6 ]. In October 2017, the 15 th Japanese Classification of Gastric Carcinoma proposed a new six-tier pathological regression evaluation for GC based on its previous Japanese Gastric Cancer Association (JGCA) TRG system[ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Comparison of tumor regression grading systems for locally advanced gastric adenocarcinoma after neoadjuvant chemotherapy

Liu¹,

Wang²,

Zhang³

et al. 2021

WJGO

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BACKGROUND Current tumor regression grade (TRG) evaluations are based on various systems which brings confusion for oncologists and pathologists when interpreting results. The recent six-tier system (JGCA2017-TRG) recommended by the Japanese Gastric Cancer Association (JGCA) is worth investigating, as four-tier TRG systems are favored in various parts of the world. AIM To compare the predictive accuracies of five published TRG systems. METHODS Data were retrospectively collected from patients with locally advanced gastric cancer (LAGC) who underwent neoadjuvant chemotherapy followed by D2 Lymphadenectomy between January 2005 and January 2014 at our institution. Outcomes were overall survival (OS) and disease-free survival (DFS), which were evaluated separately using the following TRG systems: JGCA2017, JGCA, Becker, AJCC/CAP, and Mandard. RESULTS All five published TRG systems were independent predictors for OS and DFS. Concordance indices of the JGCA2017, JGCA, Becker, AJCC/CAP-TRG, and Mandard systems were 0.651/0.648 0.652/0.649, 0.693/0.695, 0.688/0.685, and 0.674/0.675 for OS and DFS, respectively. The four-tier Becker system showed the highest c-index, which was significantly greater than that of the six-tier JGCA2017 and five-tier JGCA systems ( P < 0.05 in OS and DFS). When residual tumor percentages were reset as: “no residual tumor”, < 10%, < 100%, and “no response”, the rearranged cutoff values achieved a maximum c-index with 0.728 for OS and 0.737 for DFS, which was superior to the other five systems. CONCLUSION The newly introduced six-tier JGCA-TRG system cannot increase prognostic stratification. The four-tier Becker system is more suitable for LAGC patients. A population-based study is warranted to define the optimal criterion for TRG in LAGC patients.

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Connection and distinction of tumor regression grading systems of gastrointestinal cancer

Cited by 20 publications

References 51 publications

Prognostic value of pathological tumor regression grade in locally advanced gastric cancer: New perspectives from a single‐center experience

Prognostic value of pathological tumor regression grade in locally advanced gastric cancer: New perspectives from a single‐center experience

CA724 Predicts Tumor Regression Grade in Locally Advanced Gastric Cancer Patients with Neoadjuvant Chemotherapy

Comparison of tumor regression grading systems for locally advanced gastric adenocarcinoma after neoadjuvant chemotherapy

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