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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 ypT.
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Figure 2: Overall survival (A), disease-free survival (B), incidence of local recurrence (C), and distant metastasis (D) of patients with different ypT.

Mentions: Furthermore, we examined the prognostic significance of various clinical pathological factors (Table 1). ypT (P = 0.02, Figure 2A), ypN (P < 0.001, Supplementary Figure 1A), pCR (P = 0.041), ypStage (P < 0.001, Supplementary Figure 2A), and CA19-9 levels (P = 0.007) were all significantly associated with OS. DFS was significantly associated with ypT (P < 0.001, Figure 2B), ypN (P < 0.001, Supplementary Figure 1B), pCR (P = 0.004), ypStage (P < 0.001, Supplementary Figure 2B), lymphatic or venous invasion (P = 0.018), and perineural invasion (P = 0.01). LRFS was significantly correlated with ypT (P = 0.04, Figure 2C), lymphatic or venous invasion (P = 0.008) and perineural invasion (P = 0.007). cN (P = 0.02), ypT (P < 0.001, Figure 2D), ypN (P < 0.001, Supplementary Figure 1D), pCR (P = 0.009), ypStage (P < 0.001, Supplementary Figure 2D), and perineural invasion (P = 0.03) were all significantly associated with DMFS.


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 ypT.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: Overall survival (A), disease-free survival (B), incidence of local recurrence (C), and distant metastasis (D) of patients with different ypT.
Mentions: Furthermore, we examined the prognostic significance of various clinical pathological factors (Table 1). ypT (P = 0.02, Figure 2A), ypN (P < 0.001, Supplementary Figure 1A), pCR (P = 0.041), ypStage (P < 0.001, Supplementary Figure 2A), and CA19-9 levels (P = 0.007) were all significantly associated with OS. DFS was significantly associated with ypT (P < 0.001, Figure 2B), ypN (P < 0.001, Supplementary Figure 1B), pCR (P = 0.004), ypStage (P < 0.001, Supplementary Figure 2B), lymphatic or venous invasion (P = 0.018), and perineural invasion (P = 0.01). LRFS was significantly correlated with ypT (P = 0.04, Figure 2C), lymphatic or venous invasion (P = 0.008) and perineural invasion (P = 0.007). cN (P = 0.02), ypT (P < 0.001, Figure 2D), ypN (P < 0.001, Supplementary Figure 1D), pCR (P = 0.009), ypStage (P < 0.001, Supplementary Figure 2D), and perineural invasion (P = 0.03) were all significantly associated with DMFS.

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&ndash;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&#8202;=&#8202;0.035). Three-year DFS was 89.0% for TRG0, 74.4% for TRG1, 70.9% for TRG2, and 62% for TRG3 (P&#8202;=&#8202;0.018). By multivariate analysis, AJCC-TRG (P&#8202;=&#8202;0.033), residual lymph node metastasis (ypN+) (P&#8202;&lt;&#8202;0.001) and pretreatment CA19-9 level (P&#8202;=&#8202;0.035) were significant predictors of OS. Pathological T category (P&#8202;=&#8202;0.006) and nodal status (P&#8202;&lt;&#8202;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