Evaluation and Comparison of Predictive Value of Tumor Regression Grades according to Mandard and Becker in Locally Advanced Gastric Adenocarcinoma

Abstract

Tumor regression grade (TRG) has been widely used in gastrointestinal carcinoma to assess pathological responses to neoadjuvant chemotherapy (NCT). There are various standards without a consensus, and it is still unclear which kind of system has better predictive value. This study aims to investigate and compare the predictive ability of the Mandard and Becker TRGs in patients with locally advanced gastric cancer. Materials and Methods A total of 290 patients with locally advanced gastric adenocarcinoma who underwent NCT and curative surgery were studied. Survival analysis for overall survival (OS) and diseasefree survival (DFS) were based on the Kaplan-Meier method and Cox proportional hazards method. Predictive values of TRGs and models were assessed by time-dependent receiver operating characteristic (ROC) curve, the area under the ROC curve (AUC), nomogram, and calibration curve. Results In multivariable analysis, the Mandard TRG was associated with OS (hazard ratio [HR], 1.806; p=0.026) and DFS (HR, 1.792; p=0.017). The Becker TRG was also related to OS (HR, 1.880; p=0.014) and DFS (HR, 1.919; p=0.006). The Mandard and Becker TRG AUCs for 5-year survival were 0.72 and 0.71, respectively. The whole models showed an increased predictive value, with AUCs of 0.85 and 0.86, respectively. There was no significant difference between the two TRGs and two models. Conclusion TRG was an independent predictor for survival, and there was no significant difference between these two systems.

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

“…This conclusion is similar to other studies. In other studies, TRG was found to be associated with ypT stage [14,15,21], ypN stage [22,23], histological type [16], Lauren classification [17], differentiation grade [15,23], lymphovascular invasion [21,23] and nervous invasion [24]. Nevertheless, these characteristics after treatment could not be used as a predictor to TRG because these factors and TRG are all obtained at the stage of pathological evaluation.…”

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

“…The c-index comparison suggested that the four-tier Becker system had the best predictive value for GC patients. Because of their relatively wide measuring distance, four-tier systems based on residual percentages also mean a lower workload, easier understanding of protocols, and less inter-observer disagreement propagation[ 4 , 36 ].…”

Intratumoral heterogeneity affects tumor regression and Ki67 proliferation index in perioperatively treated gastric carcinoma

“…Another problem is the different cut-off values of the classification systems, which lead to contradictory findings on which classification best predicts patient survival [55][56][57][58]. This is further aggravated by profound intra-and interobserver variability due to subjective eyeballing in tumor regression evaluation [59].…”