Tumor Regression Grade Predicts Survival in Locally Advanced Gastric Adenocarcinoma Patients with Lymph Node Metastasis

Abstract

Background. Tumor regression grade (TRG) is widely used in gastrointestinal carcinoma to evaluate pathological responses to neoadjuvant chemotherapy (NCT), but whether it is an independent prognostic factor is still controversial. The aim of this study is to investigate the value of TRG in locally advanced gastric adenocarcinoma patients who underwent NCT and curative resection. Methods. Pathological regression was reevaluated according to the Mandard TRG. Survival curves were obtained by the Kaplan–Meier method, and differences in overall survival (OS) and disease-free survival (DFS) were compared using the log-rank test. Univariate and multivariate analyses for survival were based on the Cox proportional hazards method. Results. In total, 290 patients were identified in our electronic database. In univariable analysis, TRG was associated with OS (HR=3.822, P≤0.001) and DFS (HR=3.374, P≤0.001). However, in multivariable analysis, TRG was not an independent factor for OS (P=0.231) or DFS (P=0.191). In the stratified analysis, TRG retrieved prognostic significance in patients with the metastasis of lymph node (HR=2.034, P=0.035 for OS; HR=2.220, P=0.016 for DFS), while not in patients with negative lymph node (P=0.296 for OS; P=0.172 for DFS). Conclusions. TRG was not an independent predictor for survival, but the system regained its predicting significance in patients with lymph node metastasis.

Dynamic changes in systemic immune‐inflammation index predict pathological tumor response and overall survival in patients with gastric or gastroesophageal junction cancer receiving neoadjuvant chemotherapy

“…Firstly, it is thought that histologic tumor response does not adequately reflect chemoresistant metastatic tumor load and thus it alone would not be correlated to potential of recurrence 19,20 . Secondly, colinearity and connection between TRG and other pathological factors might lead to loss of TRG significance 21 . Additionally, the relatively small sample size of our study might have limited the assessment of TRG in predicting survival.…”

“…DFS plots stratified by change in systemic immune-inflammation index (ΔSII) F I G U R E 2 OS plots stratified by change in systemic immune-inflammation index (ΔSII) histologic tumor response does not adequately reflect chemoresistant metastatic tumor load and thus it alone would not be correlated to potential of recurrence 19,20. Secondly, colinearity and connection between TRG and other pathological factors might lead to loss of TRG significance 21. Additionally, the relatively small sample size of our study might have limited the assessment of TRG in predicting survival.Systemic inflammation has also prognostic value in solid tumors because it promotes dissemination and several inflammatory indices have been shown to predict survival in various cancers 22.…”

Morbidity and Survival After Perioperative Chemotherapy in Gastric Cancer: A Study Using the Becker’s Classification and Regression

“…POC induces a histopathological response that may be expressed through the tumor regression grading (TRG) 8 , 10 , 12 , 22 and the assessment of the effects of TNM downstaging 10 , 20 . This response provides information regarding the tumor’s chemosensitivity and helps to predict prognosis 22 .…”

“…POC induces a histopathological response that may be expressed through the tumor regression grading (TRG) 8 , 10 , 12 , 22 and the assessment of the effects of TNM downstaging 10 , 20 . This response provides information regarding the tumor’s chemosensitivity and helps to predict prognosis 22 . The TRG is a better tool to evaluate the effects of POC since the TNM downstaging results from the comparison between clinical and pathological staging and, more recently, also post-neoadjuvant therapy staging — the yTNM 8 , 22 .…”

“…This response provides information regarding the tumor’s chemosensitivity and helps to predict prognosis 22 . The TRG is a better tool to evaluate the effects of POC since the TNM downstaging results from the comparison between clinical and pathological staging and, more recently, also post-neoadjuvant therapy staging — the yTNM 8 , 22 . Clinical staging is determined through the combination of endoscopic ultrasound and CT or MRI, which provide limited information regarding the T and N, often with little precision 10 .…”