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

Lombardi, Pietro Maria; Mazzola, Michele; Achilli, Pietro; Aquilano, Maria Costanza; Martini, Paolo De; Curaba, Annabella; Gualtierotti, Monica; Bertoglio, Camillo Leonardo; Magistro, Carmelo; Ferrari, Giovanni

doi:10.1002/jso.26391

Cited by 18 publications

(21 citation statements)

References 39 publications

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“…Furthermore, multivariate analysis by Cox regression showed that the TRG was an independent risk factor affecting the prognosis of patients. This result was consistent with the findings of Lombardi et al (12), whose study included 100 GC patients who received NACT and showed that the TRG could be an independent prognostic factor by exploring the correlation between the TRG and DFS and DSS. Also, a previous meta-analysis involving 17 studies suggested that pathological response was significantly related to the improvement of OS in patients with gastroesophageal junction tumors, and proposed that the TRG should be considered a strong prognostic factor to guide postoperative treatment and followup (20).…”

Section: Discussionsupporting

confidence: 92%

“…In the field of GC, Blackham et al analyzed 58 patients with surgical resection of GC after NACT in two medical institutions and found that TRG could not predict prognostic survival of patients (11). However, Lombardi et al investigated the correlation between TRG and diseasefree survival (DFS) and disease-specific survival (DSS) in 100 GC patients treated with NACT, and found that TRG was an independent prognostic factor (12). Hence, there is no unified standard for its application in neoadjuvant therapy for GC, and the prognostic value of GC remains controversial.…”

Section: Introductionmentioning

confidence: 99%

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Prognostic value and clinicopathological correlation of the tumor regression grade in neoadjuvant chemotherapy for gastric adenocarcinoma: a retrospective cohort study

Wang¹,

Xu²,

Hu³

et al. 2022

J Gastrointest Oncol

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Background: Neoadjuvant chemotherapy (NACT) and radical gastrectomy are the gold standard treatments for resectable advanced gastric cancer (GC). However, the prognostic value of the pathological tumor regression grade (TRG) of NACT remains controversial. This retrospective study aimed to investigate the correlation between the TRG after NACT and clinicopathological features as well as its prognostic value in advanced GC. Methods: In total, 551 patients with GC who received NACT combined with surgical resection at the Zhejiang Cancer Hospital from April 2004 to December 2019 were included. The demographic characteristics, treatment response, tumor characteristics, treatment regimens, and survival data were reviewed from the medical records of all patients. The Chi-square test was used to analyze the correlation between TRG and clinicopathological factors. Kaplan-Meier univariate analysis and Cox regression multivariate analysis were used to determine the independent risk factors affecting the prognosis of GC patients.Results: Among the 551 patients with advanced GC who accepted NACT treatment, 14 were determined to be in TRG 0, 98 in TRG 1, 257 in TRG 2, and 182 in TRG 3. Also, TRG was significantly correlated with the cT stage (P=0.015), ypT stage (P<0.001), ypN stage (P<0.001), ypTNM stage (P<0.001), vascular tumor thrombus (P<0.001), Borrmann classification (P=0.042), and lymph node ratio (LNR) (P<0.001). Furthermore, patients who had a good pathological response to NACT had a better prognosis, with a 3-year overall survival (OS) of 70.9% versus 48.8% in patients who had a poor pathological response. We also found that TRG (P=0.042, HR =1.65) was an independent prognostic factor affecting the OS of GC patients.Conclusions: TRG plays a significant role in the prognostic value in neoadjuvant chemotherapy for gastric adenocarcinoma. Patients with higher cT stage, higher levels of pre-CA199 and pre-CA125 may have worse pathological response.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Prognostic value and clinicopathological correlation of the tumor regression grade in neoadjuvant chemotherapy for gastric adenocarcinoma: a retrospective cohort study

Wang¹,

Xu²,

Hu³

et al. 2022

J Gastrointest Oncol

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“…Although complete tumor regression is generally associated with the best patient outcome, there is little consensus regarding prognostic value in partial or subtotal regression. Despite these uncertainties, several studies came to the conclusion, that a TBR < 10% is significantly associated with superior survival, which we also confirmed, now using digital image analysis [18,19,60]. On the contrary, increasing the cut-off value to 20% or dividing into quartiles showed no statistical significance in our cohort.…”

Section: Neoadjuvant Chemotherapy Inhibits Rapidly Proliferating Tumo...supporting

confidence: 81%

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

et al. 2022

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Background Intratumoral heterogeneity (ITH) is a major problem in gastric cancer (GC). We tested Ki67 and tumor regression for ITH after neoadjuvant/perioperative chemotherapy. Methods 429 paraffin blocks were obtained from 106 neoadjuvantly/perioperatively treated GCs (one to five blocks per case). Serial sections were stained with Masson’s trichrome, antibodies directed against cytokeratin and Ki67, and finally digitalized. Tumor regression and three different Ki67 proliferation indices (PI), i.e., maximum PI (KiH), minimum PI (KiL), and the difference between KiH/KiL (KiD) were obtained per block. Statistics were performed in a block-wise (all blocks irrespective of their case-origin) and case-wise manner. Results Ki67 and tumor regression showed extensive ITH in our series (maximum ITH within a case: 31% to 85% for KiH; 4.5% to 95.6% for tumor regression). In addition, Ki67 was significantly associated with tumor regression (p < 0.001). Responders (<10% residual tumor, p = 0.016) exhibited prolonged survival. However, there was no significant survival benefit after cut-off values were increased ≥20% residual tumor mass. Ki67 remained without prognostic value. Conclusions Digital image analysis in tumor regression evaluation might help overcome inter- and intraobserver variability and validate classification systems. Ki67 may serve as a sensitivity predictor for chemotherapy and an indicator of ITH.

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“…The same conclusion was reached in further subgroup analysis in the ypStage II/III, LVI positive, and PNI positive groups. Different studies ( 40 , 41 ) have shown that pathological TRG grade was a predictor of OS and RFS in LAGC patients. Patients with good response had obvious tumor tissue fibrosis, less tumor residual, and down-staging, which were correlated with better prognosis.…”

Section: Discussionmentioning

confidence: 99%

Quantitative Dynamic-Enhanced MRI and Intravoxel Incoherent Motion Diffusion−Weighted Imaging for Prediction of the Pathological Response to Neoadjuvant Chemotherapy and the Prognosis in Locally Advanced Gastric Cancer

et al. 2022

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BackgroundThis study aimed to explore the predictive value of quantitative dynamic contrast-enhanced MRI (DCE-MRI) and intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) quantitative parameters for the response to neoadjuvant chemotherapy (NCT) in locally advanced gastric cancer (LAGC) patients, and the relationship between the prediction results and patients’ prognosis, so as to provide a basis for clinical individualized precision treatment.MethodsOne hundred twenty-nine newly diagnosed LAGC patients who underwent IVIM-DWI and DCE-MRI pretreatment were enrolled in this study. Pathological tumor regression grade (TRG) served as the reference standard of NCT response evaluation. The differences in DCE-MRI and IVIM-DWI parameters between pathological responders (pR) and pathological non-responders (pNR) groups were analyzed. Univariate and multivariate logistic regressions were used to identify independent predictive parameters for NCT response. Prediction models were built with statistically significant quantitative parameters and their combinations. The performance of these quantitative parameters and models was evaluated using receiver operating characteristic (ROC) analysis. Clinicopathological variables, DCE-MRI and IVIM-DWI derived parameters, as well as the prediction model were analyzed in relation to 2-year recurrence-free survival (RFS) by using Cox proportional hazards model. RFS was compared using the Kaplan–Meier method and the log-rank test.ResultsSixty-nine patients were classified as pR and 60 were pNR. Ktrans, kep, and ve values in the pR group were significantly higher, while ADCstandard and D values were significantly lower than those in the pNR group. Multivariate logistic regression analysis demonstrated that Ktrans, kep, ve, and D values were independent predictors for NCT response. The combined predictive model, which consisted of DCE-MRI and IVIM-DWI, showed the best prediction performance with an area under the curve (AUC) of 0.922. Multivariate Cox regression analysis showed that ypStage III and NCT response predicted by the IVIM-DWI model were independent predictors of poor RFS. The IVIM-DWI model could significantly stratify median RFS (52 vs. 15 months) and 2-year RFS rate (72.3% vs. 21.8%) of LAGC.ConclusionPretreatment DCE-MRI quantitative parameters Ktrans, kep, ve, and IVIM-DWI parameter D value were independent predictors of NCT response for LAGC patients. The regression model based on baseline DCE-MRI, IVIM-DWI, and their combination could help RFS stratification of LAGC patients.

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

Cited by 18 publications

References 39 publications

Prognostic value and clinicopathological correlation of the tumor regression grade in neoadjuvant chemotherapy for gastric adenocarcinoma: a retrospective cohort study

Prognostic value and clinicopathological correlation of the tumor regression grade in neoadjuvant chemotherapy for gastric adenocarcinoma: a retrospective cohort study

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

Quantitative Dynamic-Enhanced MRI and Intravoxel Incoherent Motion Diffusion−Weighted Imaging for Prediction of the Pathological Response to Neoadjuvant Chemotherapy and the Prognosis in Locally Advanced Gastric Cancer

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