Tumor regression grade combined with lymph node status in esophageal squamous cell carcinoma after neoadjuvant chemoradiotherapy

Yun, Jae Kwang; Kim, Youngwoong; Lee, Geun Dong; Choi, Sehoon; Kim, Yong‐Hee; Kim, Dong Kwan; Park, Seung‐Il; Kim, Hyeong Ryul

doi:10.1002/cam4.4748

Cited by 13 publications

(10 citation statements)

References 19 publications

(56 reference statements)

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“…In this study, pCR was also not the most important indicator in determining RFS. As for PT-TRG, numerous reports have proved that it has signi cant prognostic implications [21], but some researchers suggest that PT-TRG needs to be combined with pathological TNM staging, which can predict prognosis better in ESCC, this shows that its evaluation function is limited when PT-TRG is associated with LN metastasis [22]. Although in our study not only PT-TRG but also PT responder was not an independent prognostic factor, we could not deny the importance of assessing the responder status of the primary tumor.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Significance of positive lymph node regression grade to Neoadjuvant Chemoradiation for Esophageal Squamous Cell Carcinoma

Zhou

Liu

Guo

et al. 2023

Preprint

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Background and Purpose To assess the relationship between metastatic lymph node (LN) responder status and recurrence-free survival (RFS) in patients undergoing neoadjuvant chemoradiotherapy (NCRT).Materials and Methods We retrospectively reviewed 304 patients with local advanced esophageal squamous cell carcinoma received NCRT followed by esophagectomy. For 112 patients with positive node, according to the proportion of residual viable tumor cells area within the whole tumor beds of all metastatic LNs, we classified LN-tumor regression grade (LN-TRG) into four categories: grade 1, 0%; 2, < 10%; 3, 10–50%; 4, > 50%. Patients with grade 1 LN-TRG of were considered LN responders, and those with grades 2–4, as LN nonresponders. Univariate and multivariate analyses of recurrence-free survival (RFS) were estimated by a Cox regression model, Kaplan-Meier curve, and log-rank test.Results The median follow-up time of a total of 112 patients was 29.6 months. 52 (46.4%) patients have experienced recurrence. In Cox univariate analysis, LN responder status, nerve invasion, and lymphovascular invasion significantly correlated with RFS. Multivariate analysis for RFS revealed that LN responder status (P < 0.05) was an independent prognostic factor. The 3-year RFS rates for patients with LN-TRG of 1 to 4 grades were 72.7%, 76.5%, 37.4%, and 28.5%, respectively, and the median RFS times were not reach, 43.56 months, 28.09 months, 22.77 months, respectively.Conclusions LN responder status is an independent prognostic factor for RFS in esophageal cancer patients who received NCRT.

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Section: Discussionmentioning

confidence: 99%

Prognostic Significance of positive lymph node regression grade to Neoadjuvant Chemoradiation for Esophageal Squamous Cell Carcinoma

Zhou

Liu

Guo

et al. 2023

Preprint

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“…Therefore, we proposed a novel evaluation approach of combining TRG with ypN status. A few studies reported that the combination of TRG and ypN status had a significant association with survival for esophageal carcinoma 19,23,24 . But no such studies had been conducted for GEJ and GC patients.…”

Section: Discussionmentioning

confidence: 99%

“…A few studies reported that the combination of TRG and ypN status had a significant association with survival for esophageal carcinoma. 19,23,24 But no such studies had been conducted for GEJ and GC patients. In the present study, the combination of TRG and ypN status was recognized to be of great prognostic value for GEJ and GC.…”

Section: Discussionmentioning

confidence: 99%

Tumor regression grade combined with post‐therapy lymph node status: A novel independent prognostic factor for patients treated with neoadjuvant therapy followed by surgery in locally advanced gastroesophageal junction and gastric carcinoma

Yin,

Yao,

Xie

et al. 2023

Cancer Medicine

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BackgroundTumor regression grade (TRG) is a measure of histopathological response to neoadjuvant therapy (NAT). Post‐therapy lymph node (ypN) metastasis was reported as a prognostic factor. However, the evaluation of the treatment effectiveness of NAT has not been well studied. Here, we explored whether TRG combined with ypN status could be a prognostic factor for gastroesophageal junction (GEJ) and gastric cancer (GC). Besides, we aimed at making clear the association of different neoadjuvant regimens with different TRG and ypN status.Methods376 patients with GEJ or GC accepting NAT in Peking University Cancer Hospital were retrospectively collected from January 1, 2003 to June 30, 2021. According to TRG and ypN status, patients were innovatively categorized into four groups: TRG0N0, TRG1‐3N0, TRG0‐1N+, and TRG2‐3N+. We applied Kaplan–Meier method and log‐rank test to testify the differences in disease free survival (DFS) and overall survival (OS) among four groups. Univariate and multivariate analyses were performed to examine the relationships between TRG combined with ypN status and prognosis.ResultsWe observed significant survival differences among the four groups (p < 0.001, respectively). Median DFS and OS of patients with TRG0N0, TRG1‐3N0, and TRG0‐1N+ were not reached, whereas these of patients with TRG2‐3N+ were 17.37 months (95% CI, 14.14–20.60 months) and 39.97 months (95% CI, 27.05–52.89 months). TRG combined with ypN status was still an independent predictor for both DFS (p < 0.001) and OS (p < 0.001) in multivariate analysis. Chi‐squared test showed TRG combined with ypN status was significantly associated with different preoperative treatments (p < 0.001). Patients receiving immunotherapy achieved the highest TRG0N0 rate (31.9%).ConclusionOur results demonstrate that TRG combined with ypN status is a novel independent predictor of both DFS and OS in resectable, locally advanced GEJ and GC. Neoadjuvant immunotherapy achieved the highest TRG0N0 rate.

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“…The classi cation methods of prognosis for esophageal squamous cell carcinoma (ESCC) patients who receive nCRT followed by surgery have been explored [5,10]. However, the assessment of TRG using the modi ed Ryan scheme in the CAP Cancer Protocol for Esophageal Carcinoma recommended by the NCCN and CSCO guidelines has not evaluated with the lymph node status for the prognosis of ESCC patients.…”

Section: Introductionmentioning

confidence: 99%

Proper prognostic classification of histopathologic response to neoadjuvant chemoradiotherapy in esophageal squamous cell carcinoma

Liu,

Zhang,

Chen

et al. 2023

Preprint

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Background Accurate restaging and histological assessment of esophageal squamous cell carcinoma (ESCC) after neoadjuvant chemoradiotherapy (nCRT) provide valuable prognostic information. We aimed to elucidate proper classification methods to discriminate and predict prognosis in ESCC patients who received nCRT followed by surgery and in the recurrent subgroup. Methods We included 309 patients with ESCC who underwent nCRT followed by complete resection for analysis of overall survival (OS). Among them, 304 patients were eligible for recurrence-free survival (RFS) analysis, and OS analysis was also separately performed on 98 recurrent patients. Tumor regression grade (TRG) was assessed using the modified Ryan scheme and ypTNM was recorded based on the 8th edition of the AJCC TNM classification. The combination of TRG and lymph node status resulted in two ypTN systems: ypTN (four categories) and ypTN (three categories). In the ypTN (four categories) system, the categories were ypT-N-, ypT + N-, ypT-N+, and ypT + N+. When considering ypT + N- and ypT-N + as one category, it produced the ypTN (three categories) system. We plotted Kaplan-Meier survival curves based on various classification methods. The log-rank test was used to examine differences in survival rates and calculate P values. The selected classification methods underwent univariable and multivariable Cox regression analyses. Results The mean follow-up period was 39.2 months (range, 0.6–70.4). Compared to classification methods of TRG, ypT, ypN, ypTNM, and ypTN (four categories), ypTN (three categories) performed the best ability to distinguish and predict OS and RFS in overall population with P < 0.001 for overall models and significant differences between adjacent groups. In the recurrent population, we found the binary classification of ypN was a good predictor of OS (ypN- vs. ypN+, HR: 1.819, 95%CI: 1.150–2.878, P = 0.011). The reliability of these classification methods in both the overall population and the recurrent population was confirmed by univariable and multivariable Cox regression analyses. Conclusions The prognosis of ESCC patients who received nCRT followed by surgery can be distinguished and predicted by ypTN (three categories) system. Lymph node status was an ideal prognostic classification for the recurrent subgroup.

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Tumor regression grade combined with lymph node status in esophageal squamous cell carcinoma after neoadjuvant chemoradiotherapy

Abstract: Introduction:We aimed to elucidate the prognostic value of tumor regression grade (TRG) combined with lymph node status compared with the 8th edition of the ypTNM staging system in patients with advanced esophageal squamous cell cancer (ESCC) after neoadjuvant chemoradiotherapy (nCRT).

Cited by 13 publications

References 19 publications

Prognostic Significance of positive lymph node regression grade to Neoadjuvant Chemoradiation for Esophageal Squamous Cell Carcinoma

Prognostic Significance of positive lymph node regression grade to Neoadjuvant Chemoradiation for Esophageal Squamous Cell Carcinoma

Tumor regression grade combined with post‐therapy lymph node status: A novel independent prognostic factor for patients treated with neoadjuvant therapy followed by surgery in locally advanced gastroesophageal junction and gastric carcinoma

Proper prognostic classification of histopathologic response to neoadjuvant chemoradiotherapy in esophageal squamous cell carcinoma

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