Cancer Res Treat.  2016 Jul;48(3):998-1009. 10.4143/crt.2015.254.

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

• Kim SH
• Chang HJ
• Kim DY
• Park JW
• Baek JY
• Kim SY
• Park SC
• Oh JH
• Yu A
• Nam BH

• KMID: 2344073
• DOI: http://doi.org/10.4143/crt.2015.254

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.

Keyword

Rectal neoplasms; Chemoradiotherapy; Tumor regression grade

MeSH Terms

Chemoradiotherapy*
Humans
Joints
Lymph Nodes
Observer Variation
Prognosis
Rectal Neoplasms*

Figure

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  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. 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).

Reference

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