The relationship of pathologic tumor regression grade (TRG) and outcomes after preoperative therapy in rectal cancer Journal Article
| Authors: | Vecchio, F. M.; Valentini, V.; Minsky, B. D.; Padula, G. D. A.; Venkatraman, E. S.; Balducci, M.; Miccichè, F.; Ricci, R.; Morganti, A. G.; Gambacorta, M. A.; Maurizi, F.; Coco, C. |
| Article Title: | The relationship of pathologic tumor regression grade (TRG) and outcomes after preoperative therapy in rectal cancer |
| Abstract: | Purpose: To examine the relationship between tumor regression grade (TRG) and outcomes in patients with rectal cancer treated with preoperative therapy. Methods and Materials: Specimens from 144 patients with cT3,4 rectal cancer who had received preoperative radiation ± chemotherapy and had a minimum follow-up of 3 years were retrospectively reviewed. TRG, which involves examining the residual neoplastic cells and scoring the degree of both cytological changes, including nuclear pyknosis or necrosis and/or eosinophilia, as well as stromal changes, including fibrosis (either dense or edematous) with or without inflammatory infiltrate and giant-cell granulomatosis around ghost cells and keratin, was quantified in five grades according to the Mandard score (Cancer 1994;73:2680-2686). The greater the response, the lower the TRG score. The median follow-up was 72 months (range, 40-143 months). Results: Of the 144 patients, 19% were TRG1, 12% were TRG2, 21% were TRG3, 46% were TRG4, and 1% were TRG5. To simplify the analysis, TRG was combined into two groups: TRG1-2 and TRG3-5. By univariate analysis, none of the pretreatment factors examined, including age, circumference, length, distance from the anorectal ring, pretreatment T and N stage, and INDpre (defined as the pretreatment reference index size based on digital rectal examination), had an impact on 5-year outcomes, including local control, metastases-free survival, disease-free survival, and overall survival. Postoperative parameters, including pathologic T stage (pT), pathologic N stage (pN), and TRG, did significantly influence 5-year outcomes. These included local failure: pT0-2: 5% vs. pT3-4: 19%, p = 0.007; pN0: 7% vs. pN1-3: 26%, p = 0.002; TRG1-2: 2% vs. TRG3-5: 17%, p = 0.013; metastasis-free survival: pT0-2: 86% vs. pT3-4: 62%, p = 0.005; pN-: 86% vs. pN+: 42%, p < 0.001; TRG1-2: 91% vs. TRG3-5: 66%, p = 0.004; disease-free survival: pT0-2: 83% vs. pT3-4: 54%, p = 0.001; pN0: 80% vs. pN1-3: 39%, p < 0.001; TRG1-2: 91% vs. TRG3-5: 58%, p < 0.001; and overall survival: pT0-2: 85% vs. pT3-4: 65%, p = 0.007; pN0: 86% vs. pN1-3: 45%, p < 0.001; TRG1-2: 89% vs. TRG3-5: 68%, p = 0.004. By multivariate analysis combining all pre- and posttreatment parameters, only pN (p < 0.001) and TRG (p = 0.005) significantly predicted disease-free survival. Furthermore, TRG predicted the incidence of pathologic nodal involvement (p < 0.0001). Conclusions: By univariate analysis, TRG is a predictor for local failure, metastases-free survival, and overall survival. By multivariate analysis, it predicts improved disease-free survival. Given the ability of TRG to predict those patients with N+ disease, it may be helpful, in combination with other clinicopathologic factors, in selecting patients for a more conservative procedure, such as local excision rather than radical surgery, after preoperative therapy. © 2005 Elsevier Inc. |
| Keywords: | adult; cancer survival; controlled study; treatment outcome; aged; aged, 80 and over; disease-free survival; middle aged; retrospective studies; major clinical study; review; cisplatin; fluorouracil; combined modality therapy; chemotherapy; follow up; neoplasm staging; cytology; metastasis; cell infiltration; antineoplastic combined chemotherapy protocols; radiotherapy; incidence; tumor regression; pathology; necrosis; prediction; evaluation; neoplasm, residual; medical imaging; tumors; prognostic factors; tumor cell; remission induction; mitomycin; rectum carcinoma; analysis of variance; rectal neoplasms; diseases; cells; raltitrexed; preoperative radiotherapy; neoadjuvant chemoradiation; anorectal rings; pretreatment reference index; tumor regression grade (trg) |
| Journal Title: | International Journal of Radiation Oncology, Biology, Physics |
| Volume: | 62 |
| Issue: | 3 |
| ISSN: | 0360-3016 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2005-07-01 |
| Start Page: | 752 |
| End Page: | 760 |
| Language: | English |
| DOI: | 10.1016/j.ijrobp.2004.11.017 |
| PUBMED: | 15936556 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 140" - "Export Date: 24 October 2012" - "CODEN: IOBPD" - "Source: Scopus" |
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