Abstract
Background: In patients with locally advanced rectal cancer, the treatment response
to preoperative chemoradiotherapy (PRCRT) varies, and the ypT stage may change as
a result of tumor shrinkage. The purpose of this study was to evaluate the correlative
significance and determine the prognostic value of tumor regression grade and ypT
category staging systems.
Materials and Methods: This retrospective observational study was conducted in a tertiary
center. A total of 1240 patients with rectal cancer who underwent curative resection
after PRCRT between January 2007 and December 2016 were consecutively included.
Results: A significant association was found between the American Joint Committee
on Cancer/College of American Pathology tumor regression grading system and ypT category,
indicating a potential correlation between worse tumor regression grade and more advanced
T stage (Cramer's V = 0.255, P < .001). The ypT stage and tumor regression grade were independent predictors of
each other (P < .001). The good response group (tumor regression grades 0-1) had significantly
higher 5-year disease-free survival (85.5% vs. 68.2%, P < .001) and overall survival (92.1% vs. 81.0%, P < .001) rates than the poor response group (tumor regression grades 2-3). However,
the ypT and ypN categories were the most important independent prognostic factors
for disease-free and overall survival.
Conclusions: Tumor regression grade and ypT category were significantly correlated.
Although tumor regression grade alone is not definitive, it is closely related to
the ypT stage and impacts oncologic outcomes. These findings should be taken into
consideration when stratifying the prognosis of patients undergoing PRCRT.
Keywords
Abbreviations:
PRCRT (preoperative chemoradiotherapy), TME (total mesorectal excision), TNM (tumor-node-metastasis), AJCC (American Joint Committee on Cancer), CAP (College of American Pathologists), TRG (Tumor Regression Grade), DFS (disease-free survival), OS (overall survival), CRM (circumferential resection margin), LVI (lymphovascular invasion), PNI (perineural invasion)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Clinical Colorectal CancerAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries.CA: A Cancer J Clin. 2021; 71: 209-249
- Preoperative radiotherapy as adjuvant treatment in rectal cancer. Final results of a randomized study of the European Organization for Research and Treatment of Cancer (EORTC).Ann Surg. 1988; 208: 606-614
- Preoperative versus postoperative chemoradiotherapy for rectal cancer.N Engl J Med. 2004; 351: 1731-1740
- Chemotherapy with preoperative radiotherapy in rectal cancer.N Engl J Med. 2006; 355: 1114-1123
- Colon and Rectum.AJCC Cancer Staging Manual. 2017; : 251-274
National Comprehensive Cancer network. (2021). Rectal cancer (version: 2.2021) Available at: http://www.nccn.org/professionals/physician_gls/pdf/rectum.pdf, Accessed May 31 2021
- Predictors of pathologic complete response following neoadjuvant chemoradiotherapy for rectal cancer.Ann Surg Oncol. 2016; 23: 1177-1186
- Oncological and survival outcomes in watch and wait patients with a clinical complete response after neoadjuvant chemoradiotherapy for rectal cancer: a systematic review and pooled analysis.Ann Surg. 2018; 268: 955-967
- Is pathologic near-total regression an appropriate indicator of a good response to preoperative chemoradiotherapy based on oncologic outcome of disease?.Medicine. 2015; 94 (e2257): e2257
- Tumour regression grading after chemoradiotherapy for locally advanced rectal cancer: A near pathologic complete response does not translate into good clinical outcome.Radiother Oncol. 2014; 112: 44-51
- Prognostic implications of pathological response to neoadjuvant chemoradiation in pathologic stage III rectal cancer.Ann Surg. 2019; 269: 1117-1123
- Prognostic value of tumour regression grade in locally advanced rectal cancer: a systematic review and meta-analysis.Colorectal Dis. 2018; 20: 574-585
- Impact of tumor response on survival after radiochemotherapy in locally advanced rectal carcinoma.Am J Surg Pathol. 2010; 34: 562-568
- The relationship of pathologic tumor regression grade (TRG) and outcomes after preoperative therapy in rectal cancer.Int J Radiat Oncol Biol Phys. 2005; 62: 752-760
- Connection and distinction of tumor regression grading systems of gastrointestinal cancer.Pathol Res Pract. 2020; 216153073
- Fragmented pattern of tumor regression and lateral intramural spread may influence margin appropriateness after TEM for rectal cancer following neoadjuvant CRT.J Surg Oncol. 2014; 109: 853-858
- Prognostic value of tumor shrinkage versus fragmentation following radiochemotherapy and surgery for rectal cancer.Virchows Archiv. 2015; 466: 517-523
- The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM.Ann Surg Oncol. 2010; 17: 1471-1474
- Remaining cancer cells within the fibrosis after neo-adjuvant treatment for locally advanced rectal cancer.Eur J Surg Oncol. 2015; 41: 1204-1209
- Distribution of residual cancer cells in the bowel wall after neoadjuvant chemoradiation in patients with rectal cancer.Dis Colon Rectum. 2013; 56: 142-149
- Heterogeneous expression of Wnt/β-catenin target genes within colorectal cancer.Int J Cancer. 2007; 121: 1941-1948
- Role of tumor-associated macrophages at the invasive front in human colorectal cancer progression.Cancer Sci. 2021; 112: 2692-2704
- Invasive front of colorectal cancer: dynamic interface of pro-/anti-tumor factors.World J Gastroenterol. 2009; 15: 5898-5906
- The effects of neoadjuvant chemoradiation in locally advanced rectal cancer—the impact in intratumoral heterogeneity.Front Oncol. 2019; 9: 974
- What is the role for the circumferential margin in the modern treatment of rectal cancer?.J Clin Oncol. 2008; 26: 303-312
- American Joint Committee on Cancer and College of American Pathologists regression grade: a new prognostic factor in rectal cancer.Dis Colon Rectum. 2015; 58: 32-44
- Tumor regression grading after preoperative chemoradiotherapy for locally advanced rectal carcinoma revisited: updated results of the CAO/ARO/AIO-94 trial.J Clin Oncol. 2014; 32: 1554-1562
- Tumor regression grade after neoadjuvant chemoradiation and surgery for low rectal cancer evaluated by multiple correspondence analysis: ten years as minimum follow-up.Clin Colorectal Cancer. 2018; 17: e13-e19
- Prognostic significance of tumor regression after preoperative chemoradiotherapy for rectal cancer.J Clin Oncol. 2005; 23: 8688-8696
- Applicability of American Joint Committee on Cancer and College of American Pathologists Regression Grading System in Rectal Cancer.Dis Colon Rectum. 2017; 60: 815-826
Article info
Publication history
Published online: February 10, 2022
Accepted:
February 7,
2022
Received in revised form:
January 28,
2022
Received:
December 9,
2021
Identification
Copyright
© 2022 Published by Elsevier Inc.
