Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Sep 7;10(9):319.
doi: 10.3390/cancers10090319.

Impact of Tumor Regression Grade as a Major Prognostic Factor in Locally Advanced Rectal Cancer after Neoadjuvant Chemoradiotherapy: A Proposal for a Modified Staging System

Changhoon Song  1 , Joo-Hyun Chung  2 , Sung-Bum Kang  3 , Duck-Woo Kim  4 , Heung-Kwon Oh  5 , Hye Seung Lee  6 , Jin Won Kim  7 , Keun-Wook Lee  8 , Jee Hyun Kim  9 , Jae-Sung Kim  10
Affiliations

Impact of Tumor Regression Grade as a Major Prognostic Factor in Locally Advanced Rectal Cancer after Neoadjuvant Chemoradiotherapy: A Proposal for a Modified Staging System

Changhoon Song et al. Cancers (Basel). .

Abstract

There is ongoing debate regarding the significance of complete or near-complete response after neoadjuvant chemoradiotherapy (CRT) for rectal cancer. This study assessed the prognostic value of the Dworak tumor regression grade (TRG) following neoadjuvant CRT and surgery primarily in patients with pathological stage (ypStage) II and III rectal cancer. The records of 331 patients who underwent neoadjuvant CRT followed by total mesorectal excision between 2004 and 2015 were retrospectively reviewed. Patients were categorized as having a good response (GR, TRG 3/4, n = 122) or a poor response (PR, TRG 1/2, n = 209). At a median follow-up of 65 months, five-year disease-free survival (DFS) was higher in the GR group than in the PR group (91.3% vs. 66.6%, p < 0.001). Patients with a GR and ypStage II disease had a five-year DFS that was indistinguishable from that of patients with ypStage 0⁻I disease (92.3% vs. 90.7%, p = 0.885). Likewise, patients with a GR and ypStage III disease had a five-year DFS similar to those with ypStage II disease (76.0% vs. 75.9%, p = 0.789). A new modified staging system that incorporates grouped TRG (GR vs. PR) was developed. The prognostic performance of this modified stage and the ypStage was compared with the Harrell C statistic. C statistic of the modified stage was higher than that of the ypStage (0.784 vs. 0.757, p = 0.012). The results remained robust after multivariate Cox regression analyses. In conclusion, a GR to neoadjuvant CRT is an independent predictor of good DFS and overall survival and further stratifies patients so as to estimate the risk of recurrence and survival among patients with ypStage II and III rectal cancer.

Keywords: biomarkers; neoadjuvant chemoradiotherapy; rectal cancer; tumor regression grade.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Disease-free survival (DFS) curves are shown for categories of (a) tumor gregression grade (TRG) and (b) grouped TRG.
Figure 2
Figure 2
Disease-free survival curves are shown for categories of (a) ypStage, (b) ypStage II group was dichotomized as good response (GR) or poor response (PR), and (c) ypStage III group was dichotomized as GR or PR.
Figure 3
Figure 3
Overall survival (OS) curves are shown for categories of (a) TRG and (b) grouped TRG.
Figure 4
Figure 4
Overall survival curves are shown for categories of (a) ypStage, (b) ypStage II group was dichotomized as GR or PR, and (c) ypStage III group was dichotomized as GR or PR.
Figure 5
Figure 5
Kaplan-Meier curves for DFS comparing (a) the American Joint Committee on Cancer (AJCC) ypStaging and (b) the new modified staging system.
Figure 6
Figure 6
Kaplan-Meier curves for OS comparing (a) the AJCC ypStaging and (b) the new modified staging system.
See this image and copyright information in PMC

References

    1. Sauer R., Becker H., Hohenberger W., Rodel C., Wittekind C., Fietkau R., Martus P., Tschmelitsch J., Hager E., Hess C.F., et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N. Engl. J. Med. 2004;351:1731–1740. doi: 10.1056/NEJMoa040694. - DOI - PubMed
    1. Gantt G.A., Chen Y., Dejulius K., Mace A.G., Barnholtz-Sloan J., Kalady M.F. Gene expression profile is associated with chemoradiation resistance in rectal cancer. Colorectal Dis. 2014;16:57–66. doi: 10.1111/codi.12395. - DOI - PubMed
    1. Rampazzo E., Del Bianco P., Bertorelle R., Boso C., Perin A., Spiro G., Bergamo F., Belluco C., Buonadonna A., Palazzari E., et al. The predictive and prognostic potential of plasma telomerase reverse transcriptase (tert) rna in rectal cancer patients. Br. J. Cancer. 2018;118:878–886. doi: 10.1038/bjc.2017.492. - DOI - PMC - PubMed
    1. Spolverato G., Pucciarelli S., Bertorelle R., De Rossi A., Nitti D. Predictive factors of the response of rectal cancer to neoadjuvant radiochemotherapy. Cancers. 2011;3:2176–2194. doi: 10.3390/cancers3022176. - DOI - PMC - PubMed
    1. Ho V., Chung L., Singh A., Lea V., Revoltar M., Lim S.H., Tut T.G., Ng W., Lee M., de Souza P., et al. Early postoperative low expression of rad50 in rectal cancer patients associates with disease-free survival. Cancers. 2017;9:163. doi: 10.3390/cancers9120163. - DOI - PMC - PubMed

LinkOut - more resources