Pathological Assessment of the AJCC Tumor Regression Grading System After Preoperative Chemoradiotherapy for Chinese Locally Advanced Rectal Cancer

Zhang, Luning; Xiao, Weiwei; Xi, Shaoyan; OuYang, Pu‐Yun; You, Kaiyun; Zeng, Zhifan; Ding, Pei-Rong; Zhang, Huizhong; Pan, Zhizhong; Xu, Rui‐Hua; Gao, Yuanhong

doi:10.1097/md.0000000000002272

Cited by 18 publications

(22 citation statements)

References 30 publications

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“…Meanwhile, CA 19-9 is another widely used tumor marker in gastrointestinal tumor and is a significant predictor of survival for rectal cancer 30–32. However, few studies analyzed the association between CA19-9 and nCRT response.…”

Section: Discussionmentioning

confidence: 99%

Predictive value of carcinoembryonic antigen and carbohydrate antigen 19-9 related to downstaging to stage 0–I after neoadjuvant chemoradiotherapy in locally advanced rectal cancer

Song¹,

Huang²,

Chen³

et al. 2018

CMAR

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ObjectiveTo explore the value of carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) in predicting downstaging to stage 0–I cancer after neoadjuvant chemoradiotherapy (nCRT) in locally advanced rectal cancer.Materials and methodsWe respectively investigated pretreatment CEA, pretreatment CA19-9, posttreatment CEA, posttreatment CA19-9, pre–post-CA19-9 ratio, and pre–post-CEA ratio in 674 patients with locally advanced rectal cancer receiving nCRT and determined the patients’ thresholds by using the receiver operating characteristic curve analysis. The association between downstaging (stage 0–I after nCRT), pathological complete response, and clinicopathological parameters was evaluated using the Pearson χ2 test. The clinicopathological parameters which were found to be significantly associated with downstaging were analyzed by logistic regression models and were incorporated into a scoring system.ResultsMultivariate analysis showed that pretreatment CA19-9 level, posttreatment CEA level, pre–post-CEA ratio, and pre–post-CA19-9 ratio were significantly correlated with downstaging. Area under the curve of the scoring system was higher than that of parameters alone.ConclusionThe 4-factor scoring system with CA19-9 level, posttreatment CEA level, pre– post-CEA ratio, and pre–post-CA19-9 ratio is of more value in predicting downstaging to stage 0–I patients with locally advanced rectal cancer after nCRT than using the parameters alone.

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Section: Discussionmentioning

confidence: 99%

Predictive value of carcinoembryonic antigen and carbohydrate antigen 19-9 related to downstaging to stage 0–I after neoadjuvant chemoradiotherapy in locally advanced rectal cancer

Song¹,

Huang²,

Chen³

et al. 2018

CMAR

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“…TRG is a type of grading metric used in the histological stratification of tumor response after chemoradiotherapy, and it was first used in the evaluation of the efficacy of concurrent chemoradiotherapy in esophageal, gastric, bladder, and head and neck cancers. 13 – 17 Later, studies reported that TRG had a significant correlation with the prognosis of LARC, 6 – 10 and it was gradually used to evaluate the progression of rectal cancer. There are mainly 6 types of TRG systems at present, which divide the TRG into 3–5 grades, but no unified standards have yet been established.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have shown that the tumor regression grade (TRG) had significant correlation with the prognosis of LARC 6 – 10 and is gradually being used to assess the progression of rectal cancer. Thus far, mainly six types of TRG systems have been used, and the American Joint Committee on Cancer (AJCC)-TRG has been found to be better than any other system as it can be more accurate in predicting the occurrence of distant metastasis (DM) due to rectal cancer.…”

Section: Introductionmentioning

confidence: 99%

ypTNM category combined with AJCC tumor regression grade for screening patients with the worst prognosis after neoadjuvant chemoradiation therapy for locally advanced rectal cancer

Wei¹,

Huang²,

Guo³

et al. 2018

CMAR

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BackgroundThe purpose of this study was to investigate the value of the postsurgical pathological T and N (ypTN) category combined with the American Joint Committee on Cancer-tumor regression grade (AJCC-TRG) in evaluating the prognosis of neoadjuvant chemoradiation therapy (NeoCRT) for locally advanced rectal cancer (LARC) to screen for a subgroup of patients with the worst prognosis.Patients and methodsIn total, 265 patients with LARC were enrolled in the trial. All patients received NeoCRT. Total mesorectal excision was performed 6–8 weeks after the completion of radiotherapy. The surgical specimens were re-evaluated based on the AJCC-TRG (seventh edition) and the AJCC-tumor-node-metastasis (TNM; seventh edition) systems. We followed up these patients and calculated their overall survival (OS), disease-free survival (DFS), local recurrence-free survival (RFS), and distant metastasis (DM)-free survival (MFS) rates through the Kaplan–Meier analysis. The logrank test was further applied to evaluate the predictive value of the ypTN stage combined with AJCC-TRG for several survival indexes.ResultsThe median follow-up period was 65.1 months. The 5-year OS, DFS, RFS, and MFS rates were 79.4%, 68.8%, 94.4%, and 76.5%, respectively. There were significant differences in OS, DFS, and MFS rates among different ypT+AJCC-TRG and ypN+AJCC-TRG subgroups. The 5-year OS, DFS, and MFS rates for ypT3–4+TRG 1 and ypT3–4+TRG2–3 subgroups were 73.9% vs 65.3%, 61.2% vs 52.9%, and 65.0% vs 61.5%, respectively. The 5-year OS, DFS, and MFS rates for ypN1–2+TRG 0–1 and ypN1–2+TRG2–3 subgroups were 64.8% vs 54.1%, 44.9% vs 41.7%, and 61.4% vs 46.3%, respectively.ConclusionThe ypTNM category combined with the AJCC-TRG can more accurately evaluate the prognosis of patients with LARC and identify the subgroup of patients with the worst prognosis and high risk of developing DM, thereby demonstrating clinical significance in guiding individualized postoperative adjuvant therapy and follow-up for LARC.

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“…A blood sample of patients was collected after each cycle of chemotherapy. Carbohydrate antigen 19-9 and serum carcinoembryonic antigen in blood samples were evaluated by a pathologist who was blind to the chemotherapeutic treatments [ 20 ].…”

Section: Methodsmentioning

confidence: 99%

Comparisons of Efficacy, Safety, and Cost of Chemotherapy Regimens FOLFOX4 and FOLFIRINOX in Rectal Cancer: A Randomized, Multicenter Study

Qiang

Liu

et al. 2018

Med Sci Monit

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BackgroundThe currently available chemotherapeutic regimens do not use a specifically designed drug delivery system. The objective of this study was to compare outcome measures, adverse effects, and cost of FOLFOX4 and FOLFIRINOX treatments in rectal cancer patients.Material/MethodsWe enrolled patients who, after surgery, did not undergo chemotherapy or radiotherapy (Control group); were administered 200 mg/m2 folinic acid, 400 mg/m2 fluorouracil, and 85 mg/m2 oxaliplatin (FFO group); or were administered 400 mg/m2 folinic acid, 400 mg/m2 fluorouracil, 180 mg/m2 irinotecan, and 85 mg/m2 oxaliplatin (FFIO group). We recorded tumor and nodal staging, carbohydrate antigen 19-9, serum carcinoembryonic antigen, total cost of treatment, disease recurrence, overall survival, and adverse effects. We used the 2-tailed paired t test following Turkey post hoc test for adverse effects, recurrence analysis, and cost of treatment at 95% of confidence level.ResultsSurgery (p=0.00089), FOLFOX4 (p=0.000167), and FOLFIRINOX (p=0.00013) improved disease-free conditions. Only surgery failed to maintain carbohydrate antigen and carcinoembryonic antigen 19-9 levels. The cost of chemotherapeutic treatments was in the order of FFIO group > FFO group > Control group. Non-fatal treatment-emergent adverse effects were due to chemotherapeutic drugs. However, fatal chemotherapeutic treatment-emergent adverse effects were observed only in the FFIO group. Overall survival, irrespective of cancerous condition, was higher in the FFO group.ConclusionsFOLFIRINOX had less total cancer recurrence than FOLFOX4. However, FOLFIRINOX had more fatal treatment-emergent adverse effects and excessive cost of treatment than FOLFOX4 regimen.

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Pathological Assessment of the AJCC Tumor Regression Grading System After Preoperative Chemoradiotherapy for Chinese Locally Advanced Rectal Cancer

Abstract: Supplemental Digital Content is available in the text

Cited by 18 publications

References 30 publications

Predictive value of carcinoembryonic antigen and carbohydrate antigen 19-9 related to downstaging to stage 0–I after neoadjuvant chemoradiotherapy in locally advanced rectal cancer

Predictive value of carcinoembryonic antigen and carbohydrate antigen 19-9 related to downstaging to stage 0–I after neoadjuvant chemoradiotherapy in locally advanced rectal cancer

ypTNM category combined with AJCC tumor regression grade for screening patients with the worst prognosis after neoadjuvant chemoradiation therapy for locally advanced rectal cancer

Comparisons of Efficacy, Safety, and Cost of Chemotherapy Regimens FOLFOX4 and FOLFIRINOX in Rectal Cancer: A Randomized, Multicenter Study

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Pathological Assessment of the AJCC Tumor Regression Grading System After Preoperative Chemoradiotherapy for Chinese Locally Advanced Rectal Cancer

Abstract: Supplemental Digital Content is available in the text

Cited by 18 publications

References 30 publications

Predictive value of carcinoembryonic antigen and carbohydrate antigen 19-9 related to downstaging to stage 0&ndash;I after neoadjuvant chemoradiotherapy in locally advanced rectal cancer

Predictive value of carcinoembryonic antigen and carbohydrate antigen 19-9 related to downstaging to stage 0&ndash;I after neoadjuvant chemoradiotherapy in locally advanced rectal cancer

ypTNM category combined with AJCC tumor regression grade for screening patients with the worst prognosis after neoadjuvant chemoradiation therapy for locally advanced rectal cancer

Comparisons of Efficacy, Safety, and Cost of Chemotherapy Regimens FOLFOX4 and FOLFIRINOX in Rectal Cancer: A Randomized, Multicenter Study

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Predictive value of carcinoembryonic antigen and carbohydrate antigen 19-9 related to downstaging to stage 0–I after neoadjuvant chemoradiotherapy in locally advanced rectal cancer

Predictive value of carcinoembryonic antigen and carbohydrate antigen 19-9 related to downstaging to stage 0–I after neoadjuvant chemoradiotherapy in locally advanced rectal cancer