Histopathological regression grading matches excellently with local and regional spread after neoadjuvant therapy of rectal cancer

Elezkurtaj, Sefer; Moser, Lutz; Budczies, Jan; Müller, Alice Josephine; Bläker, Hendrik; Buhr, H. J.; Dietel, Manfred; Kruschewski, M.

doi:10.1016/j.prp.2013.04.009

Cited by 9 publications

(6 citation statements)

References 43 publications

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“…Based on the findings from previous studies [ 12 , 13 , 15 , 39 , 40 ], patients were categorized as having a GR (TRG 3 or 4) or a PR (TRG 1 or 2) to neoadjuvant CRT. CRM involvement was considered positive if a microscopic tumor was found ≤1 mm from the resection margin [ 41 , 42 ].…”

Section: Methodsmentioning

confidence: 99%

Impact of Tumor Regression Grade as a Major Prognostic Factor in Locally Advanced Rectal Cancer after Neoadjuvant Chemoradiotherapy: A Proposal for a Modified Staging System

Song

Chung

Kang

et al. 2018

Cancers

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There is ongoing debate regarding the significance of complete or near-complete response after neoadjuvant chemoradiotherapy (CRT) for rectal cancer. This study assessed the prognostic value of the Dworak tumor regression grade (TRG) following neoadjuvant CRT and surgery primarily in patients with pathological stage (ypStage) II and III rectal cancer. The records of 331 patients who underwent neoadjuvant CRT followed by total mesorectal excision between 2004 and 2015 were retrospectively reviewed. Patients were categorized as having a good response (GR, TRG 3/4, n = 122) or a poor response (PR, TRG 1/2, n = 209). At a median follow-up of 65 months, five-year disease-free survival (DFS) was higher in the GR group than in the PR group (91.3% vs. 66.6%, p < 0.001). Patients with a GR and ypStage II disease had a five-year DFS that was indistinguishable from that of patients with ypStage 0–I disease (92.3% vs. 90.7%, p = 0.885). Likewise, patients with a GR and ypStage III disease had a five-year DFS similar to those with ypStage II disease (76.0% vs. 75.9%, p = 0.789). A new modified staging system that incorporates grouped TRG (GR vs. PR) was developed. The prognostic performance of this modified stage and the ypStage was compared with the Harrell C statistic. C statistic of the modified stage was higher than that of the ypStage (0.784 vs. 0.757, p = 0.012). The results remained robust after multivariate Cox regression analyses. In conclusion, a GR to neoadjuvant CRT is an independent predictor of good DFS and overall survival and further stratifies patients so as to estimate the risk of recurrence and survival among patients with ypStage II and III rectal cancer.

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Section: Methodsmentioning

confidence: 99%

Impact of Tumor Regression Grade as a Major Prognostic Factor in Locally Advanced Rectal Cancer after Neoadjuvant Chemoradiotherapy: A Proposal for a Modified Staging System

Song

Chung

Kang

et al. 2018

Cancers

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“…The Dworak scale uses a similar numerical scale in the opposite direction to the Mandard system. From the articles that use the Dworak classification for their definitions[ 14 - 16 , 20 , 25 , 26 , 29 , 33 ], a poor response was defined as Dworak 0 to 1, 1, 1 to 2 or 0 to 2.…”

Section: Resultsmentioning

confidence: 99%

“…Six scales[ 18 , 25 , 35 , 40 , 43 , 44 , 46 ] were used in 20 reports (16 articles) to define good response[ 13 - 16 , 18 , 20 , 21 , 24 - 26 , 28 - 33 ]. These six scales produced 12 different definitions of good response (Table 2 ).…”

Section: Resultsmentioning

confidence: 99%

Defining response to radiotherapy in rectal cancer using magnetic resonance imaging and histopathological scales

Siddiqui

Bhoday

Battersby

et al. 2016

WJG

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AIMTo define good and poor regression using pathology and magnetic resonance imaging (MRI) regression scales after neo-adjuvant chemotherapy for rectal cancer.METHODSA systematic review was performed on all studies up to December 2015, without language restriction, that were identified from MEDLINE, Cochrane Controlled Trials Register (1960-2015), and EMBASE (1991-2015). Searches were performed of article bibliographies and conference abstracts. MeSH and text words used included “tumour regression”, “mrTRG”, “poor response” and “colorectal cancers”. Clinical studies using either MRI or histopathological tumour regression grade (TRG) scales to define good and poor responders were included in relation to outcomes [local recurrence (LR), distant recurrence (DR), disease-free survival (DFS), and overall survival (OS)]. There was no age restriction or stage of cancer restriction for patient inclusion. Data were extracted by two authors working independently and using pre-defined outcome measures.RESULTSQuantitative data (prevalence) were extracted and analysed according to meta-analytical techniques using comprehensive meta-analysis. Qualitative data (LR, DR, DFS and OS) were presented as ranges. The overall proportion of poor responders after neo-adjuvant chemo-radiotherapy (CRT) was 37.7% (95%CI: 30.1-45.8). There were 19 different reported histopathological scales and one MRI regression scale (mrTRG). Clinical studies used nine and six histopathological scales for poor and good responders, respectively. All studies using MRI to define good and poor response used one scale. The most common histopathological definition for good response was the Mandard grades 1 and 2 or Dworak grades 3 and 4; Mandard 3, 4 and 5 and Dworak 0, 1 and 2 were used for poor response. For histopathological grades, the 5-year outcomes for poor responders were LR 3.4%-4.3%, DR 14.3%-20.3%, DFS 61.7%-68.1% and OS 60.7-69.1. Good pathological response 5-year outcomes were LR 0%-1.8%, DR 0%-11.6%, DFS 78.4%-86.7%, and OS 77.4%-88.2%. A poor response on MRI (mrTRG 4,5) resulted in 5-year LR 4%-29%, DR 9%, DFS 31%-59% and OS 27%-68%. The 5-year outcomes with a good response on MRI (mrTRG 1,2 and 3) were LR 1%-14%, DR 3%, DFS 64%-83% and OS 72%-90%.CONCLUSIONFor histopathology regression assessment, Mandard 1, 2/Dworak 3, 4 should be used for good response and Mandard 3, 4, 5/Dworak 0, 1, 2 for poor response. MRI indicates good and poor response by mrTRG1-3 and mrTRG4-5, respectively.

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“…How ever, cases with poor histological re sponse were strongly rep re sented in ypN0. 43 Fur thermore, the mod i fied Dworak TRG sys tem for eval u a tion of en tire tu mors in clud ing re gional lymph nodes seems to be even better pre dic tor of sur vival than cur rent TRG sys tems for eval u a tion of the pri mary tu mor alone. 44 But, it was re cently doc u mented that out comes in patients with LARC un der went nCT are linked to fourtiered CAP re gres sion grade scor ing sys tem.…”

Section: Prog Nos Tic Sig Nif I Cance Of Trgmentioning

confidence: 98%

Histopathological evaluation of response to neoadjuvant chemoradiotherapy in locally advanced rectal carcinoma

Micev¹,

Micev-Cosic²,

Rom³

et al. 2016

ACTA CHIR IUG

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Histopathological regression grading matches excellently with local and regional spread after neoadjuvant therapy of rectal cancer

Cited by 9 publications

References 43 publications

Impact of Tumor Regression Grade as a Major Prognostic Factor in Locally Advanced Rectal Cancer after Neoadjuvant Chemoradiotherapy: A Proposal for a Modified Staging System

Impact of Tumor Regression Grade as a Major Prognostic Factor in Locally Advanced Rectal Cancer after Neoadjuvant Chemoradiotherapy: A Proposal for a Modified Staging System

Defining response to radiotherapy in rectal cancer using magnetic resonance imaging and histopathological scales

Histopathological evaluation of response to neoadjuvant chemoradiotherapy in locally advanced rectal carcinoma

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