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Comparative Study
. 2016 Jul;48(3):998-1009.
doi: 10.4143/crt.2015.254. Epub 2015 Oct 22.

What Is the Ideal Tumor Regression Grading System in Rectal Cancer Patients after Preoperative Chemoradiotherapy?

Soo Hee Kim  1 , Hee Jin Chang  1   2 , Dae Yong Kim  2 , Ji Won Park  3 , Ji Yeon Baek  2 , Sun Young Kim  2 , Sung Chan Park  2 , Jae Hwan Oh  2 , Ami Yu  4 , Byung-Ho Nam  4
Affiliations
Comparative Study

What Is the Ideal Tumor Regression Grading System in Rectal Cancer Patients after Preoperative Chemoradiotherapy?

Soo Hee Kim et al. Cancer Res Treat. 2016 Jul.

Abstract

Purpose: Tumor regression grade (TRG) is predictive of therapeutic response in rectal cancer patients after chemoradiotherapy (CRT) followed by curative resection. However, various TRG systems have been suggested, with subjective categorization, resulting in interobserver variability. This study compared the prognostic validity of four different TRG systems in order to identify the most ideal TRG system.

Materials and methods: This study included 933 patients who underwent preoperative CRT and curative resection. Primary tumors alone were graded according to the American Joint Committee on Cancer (AJCC), Dworak, and Ryan TRG systems, and both primary tumors and regional lymph nodes were graded according to a modified Dworak TRG system. The ability of each TRG system to predict recurrence-free survival (RFS) and overall survival (OS) was analyzed using chi-square and C statistics.

Results: All four TRG systems were significantly predictive of both RFS and OS (p < 0.001 each), however none was a better predictor of prognosis than ypStage. Among the four TRGs, the mDworak TRG system was a better predictor of RFS and OS than the AJCC, Dworak, and Ryan TRG systems, and both the chi-square and C statistics were higher for the former, although the differences were not statistically significant. The combination of ypStage and the modified Dworak TRG better predicted RFS and OS than ypStage alone.

Conclusion: The modified Dworak TRG system for evaluation of entire tumors including regional lymph nodes is a better predictor of survival than current TRG systems for evaluation of the primary tumor alone.

Keywords: Chemoradiotherapy; Rectal neoplasms; Tumor regression grade.

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Conflict of interest statement

Conflict of interest relevant to this article was not reported

Figures

Fig. 1.
Fig. 1.
Relapse-free survival of 933 rectal cancer patients treated with pre-operative chemoradiotherapy followed by surgical resection, according to tumor regression grades (TRG) according to the modified Dworak (mDworak) system (A), which assesses both the primary tumor and regional lymph nodes, the American Joint Committee on Cancer (AJCC) system (B), which assesses the primary tumor alone, and ypStage (C).
Fig. 2.
Fig. 2.
Overall survival of 933 rectal cancer patients treated with pre-operative chemoradiotherapy followed by surgical resection, according to tumor regression grades (TRG) according to the modified Dworak (mDworak) system (A), which assesses both the primary tumor and regional lymph nodes, the American Joint Committee on Cancer (AJCC) system (B), which assesses the primary tumor alone, and ypStage (C).
See this image and copyright information in PMC

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