Prognostic significance of tumour regression grade after neoadjuvant chemoradiotherapy for a cohort of patients with locally advanced rectal cancer: an 8-year retrospective single-institutional study

Abstract

Aim: Locally advanced rectal cancer (LARC) is frequently treated with neoadjuvant chemoradiotherapy (NACRT) to reduce the risk of local recurrence and improve survival. Tumour response to NACRT is variable and may influence the prognosis after subsequent surgery. This study compared the prognostic values of tumour regression grade (TRG) and neoadjuvant pathological (ypTNM) downstaging in patients with Stage II and III rectal cancer treated with NACRT followed by curative surgery.

Method: This study included 185 patients with LARC treated with long-course radiotherapy (45 Gy in 25 fractions) plus 5-fluorouracil over 5 weeks between 2005 and 2013. We used multivariate analysis to assess the relationship of Dworak's five-tier TRG, ypTNM stage and ypTNM downstaging with clinicopathological factors, 5-year disease-free survival (DFS) and 5-year overall survival (OS).

Results: Total regression (TRG4), good regression (TRG3), moderate regression (TRG2), minor regression (TRG1) and no regression (TRG0) were seen in 38 (20.6%), 65 (35.2%), 43 (23.2%), 28 (15.1%) and 11 (5.9%) patients, respectively. TNM downstaging following NACRT occurred in 109 (58.9%) patients. The 5-year DFS rates after NACRT for TRG0, TRG1, TRG2, TRG3 and TRG4 were 0%, 58.5%, 66.4%, 80.4% and 82.6%, respectively (P < 0.001). The ypTNM stage correlated with 5-year DFS (P = 0.004) but not 5-year OS (P = 0.075). Multivariate analysis demonstrated that TRG was related to both DFS and OS (P < 0.001).

Conclusion: TRG measured on a five-tier system was better than ypTNM stage for predicting outcome in patients with LARC treated with NACRT and surgery.

Keywords: Locally advanced rectal cancer; disease-free survival; neoadjuvant chemoradiotherapy; overall survival; tumour regression grade; ypTNM downstaging.