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Pathological Assessment of the AJCC Tumor Regression Grading System After Preoperative Chemoradiotherapy for Chinese Locally Advanced Rectal Cancer

View Article: PubMed Central - PubMed

ABSTRACT

We used American Joint Committee on Cancer (AJCC) Staging Manual system to assess the prognostic significance of tumor regression grading (TRG) for locally advanced rectal cancer (LARC) (T3/4 or N+) patients who were treated with preoperative chemoradiotherapy (CRT).

The 4 AJCC-TRG classifications were evaluated on surgical specimens from 295 LARC patients receiving CRT. Overall survival (OS), disease-free survival (DFS), local recurrence-free survival (LRFS), and distant metastasis-free survival (DMFS) were estimated using Kaplan–Meier method and Cox regression model.

Classifications of TRG 0, 1, 2, and 3 were found in 27.5%, 19.3%, 45.7%, and 7.5% of the resected specimens, respectively. Three-year OS was 95.5% for TRG0, 91.5% for TRG1, 84.8% for TRG2, and 85.7% for TRG3 (P = 0.035). Three-year DFS was 89.0% for TRG0, 74.4% for TRG1, 70.9% for TRG2, and 62% for TRG3 (P = 0.018). By multivariate analysis, AJCC-TRG (P = 0.033), residual lymph node metastasis (ypN+) (P < 0.001) and pretreatment CA19-9 level (P = 0.035) were significant predictors of OS. Pathological T category (P = 0.006) and nodal status (P < 0.001) after CRT were the most important independent prognostic factors for DFS.

AJCC-TRG is a prognostic factor for LARC patients receiving CRT, independent of pathological staging.

No MeSH data available.


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Overall survival (A), disease-free survival (B), incidence of local recurrence (C), and distant metastasis (D) of patients with different TRG classification. TRG = tumor regression grade.
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Figure 1: Overall survival (A), disease-free survival (B), incidence of local recurrence (C), and distant metastasis (D) of patients with different TRG classification. TRG = tumor regression grade.

Mentions: In univariate analysis, TRG was significantly associated with OS (P = 0.035) and DFS (P = 0.018; Figure 1A, B). The 3-year OS rates were 95.5%, 91.5%, 84.8%, and 85.7% in patients with TRG0, TGR1, TRG2, and TRG3, respectively. The 3-year DFS rates were 89.0%, 74.4%, 70.9%, and 62.0% for patients with TRG0, TRG1, TRG2, and TRG3, respectively. Additionally, a clear trend toward less local recurrence was observed for TRG0, with a cumulative incidence of 2.3% compared with 1.8% for TRG1, 5.2% for TRG2, and 15.6% for TRG3 (P = 0.052, Figure 1C). A similar increasing trend was also observed for the cumulative incidence of distant metastasis (8.9%, 21.4%, 22.1%, and 34.1% for TRG0, TRG1, TRG2, and TRG3, respectively; P = 0.056; Figure 1D).


Pathological Assessment of the AJCC Tumor Regression Grading System After Preoperative Chemoradiotherapy for Chinese Locally Advanced Rectal Cancer
Overall survival (A), disease-free survival (B), incidence of local recurrence (C), and distant metastasis (D) of patients with different TRG classification. TRG = tumor regression grade.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4998237&req=5

Figure 1: Overall survival (A), disease-free survival (B), incidence of local recurrence (C), and distant metastasis (D) of patients with different TRG classification. TRG = tumor regression grade.
Mentions: In univariate analysis, TRG was significantly associated with OS (P = 0.035) and DFS (P = 0.018; Figure 1A, B). The 3-year OS rates were 95.5%, 91.5%, 84.8%, and 85.7% in patients with TRG0, TGR1, TRG2, and TRG3, respectively. The 3-year DFS rates were 89.0%, 74.4%, 70.9%, and 62.0% for patients with TRG0, TRG1, TRG2, and TRG3, respectively. Additionally, a clear trend toward less local recurrence was observed for TRG0, with a cumulative incidence of 2.3% compared with 1.8% for TRG1, 5.2% for TRG2, and 15.6% for TRG3 (P = 0.052, Figure 1C). A similar increasing trend was also observed for the cumulative incidence of distant metastasis (8.9%, 21.4%, 22.1%, and 34.1% for TRG0, TRG1, TRG2, and TRG3, respectively; P = 0.056; Figure 1D).

View Article: PubMed Central - PubMed

ABSTRACT

We used American Joint Committee on Cancer (AJCC) Staging Manual system to assess the prognostic significance of tumor regression grading (TRG) for locally advanced rectal cancer (LARC) (T3/4 or N+) patients who were treated with preoperative chemoradiotherapy (CRT).

The 4 AJCC-TRG classifications were evaluated on surgical specimens from 295 LARC patients receiving CRT. Overall survival (OS), disease-free survival (DFS), local recurrence-free survival (LRFS), and distant metastasis-free survival (DMFS) were estimated using Kaplan–Meier method and Cox regression model.

Classifications of TRG 0, 1, 2, and 3 were found in 27.5%, 19.3%, 45.7%, and 7.5% of the resected specimens, respectively. Three-year OS was 95.5% for TRG0, 91.5% for TRG1, 84.8% for TRG2, and 85.7% for TRG3 (P = 0.035). Three-year DFS was 89.0% for TRG0, 74.4% for TRG1, 70.9% for TRG2, and 62% for TRG3 (P = 0.018). By multivariate analysis, AJCC-TRG (P = 0.033), residual lymph node metastasis (ypN+) (P < 0.001) and pretreatment CA19-9 level (P = 0.035) were significant predictors of OS. Pathological T category (P = 0.006) and nodal status (P < 0.001) after CRT were the most important independent prognostic factors for DFS.

AJCC-TRG is a prognostic factor for LARC patients receiving CRT, independent of pathological staging.

No MeSH data available.


Related in: MedlinePlus