Cancer Res Treat.  2021 Jan;53(1):112-122. 10.4143/crt.2020.516.

Evaluation and Comparison of Predictive Value of Tumor Regression Grades according to Mandard and Becker in Locally Advanced Gastric Adenocarcinoma

• Tong Y
• Zhu Y
• Zhao Y
• Shan Z
• Liu D
• Zhang J

• KMID: 2510653
• DOI: http://doi.org/10.4143/crt.2020.516

Abstract

Purpose
Tumor regression grade (TRG) has been widely used in gastrointestinal carcinoma to assess pathological responses to neoadjuvant chemotherapy (NCT). There are various standards without a consensus, and it is still unclear which kind of system has better predictive value. This study aims to investigate and compare the predictive ability of the Mandard and Becker TRGs in patients with locally advanced gastric cancer.
Materials and Methods
A total of 290 patients with locally advanced gastric adenocarcinoma who underwent NCT and curative surgery were studied. Survival analysis for overall survival (OS) and disease-free survival (DFS) were based on the Kaplan-Meier method and Cox proportional hazards method. Predictive values of TRGs and models were assessed by time-dependent receiver operating characteristic (ROC) curve, the area under the ROC curve (AUC), nomogram, and calibration curve.
Results
In multivariable analysis, the Mandard TRG was associated with OS (hazard ratio [HR], 1.806; p=0.026) and DFS (HR, 1.792; p=0.017). The Becker TRG was also related to OS (HR, 1.880; p=0.014) and DFS (HR, 1.919; p=0.006). The Mandard and Becker TRG AUCs for 5-year survival were 0.72 and 0.71, respectively. The whole models showed an increased predictive value, with AUCs of 0.85 and 0.86, respectively. There was no significant difference between the two TRGs and two models.
Conclusion
TRG was an independent predictor for survival, and there was no significant difference between these two systems.

Keyword

Stomach neoplasms; Tumor regression grade; Neoadjuvant chemotherapy; Pathological assessment; Prognosis

Figure

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  Fig. 1. (A-E) Examples of Mandard tumor regression grade (TRG) (×40). (A) TRG 1, complete tumor regression. (B) TRG 2, rare residual tumor. (C) TRG 3, more residual tumor but less than fibrosis. (D) TRG 4, residual tumor with signs of regression. (E) TRG 5, residual tumor without regression. (F-I) Examples of Becker TRG (×40). (F) TRG 1a, complete tumor regression. (G) TRG 1b, < 10% residual tumor. (H) TRG 2, 10%-50% residual tumor. (I) TRG 3, > 50% residual tumor.

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  Fig. 2. Kaplan-Meier curves for overall survival of Mandard tumor regression grade (TRG) (A) and Becker TRG (B). When grouped into responders and non-responders, Mandard TRG 3-5 (hazard ratio [HR], 3.822; 95% confidence interval [CI], 2.371 to 6.162; p < 0.001) and Becker TRG 2-3 (HR, 3.876; 95% CI, 2.427 to 6.192; p < 0.001) owned worse prognosis.

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  Fig. 3. Nomograms of Mandard tumor regression grade (TRG) model (A) and Becker TRG model (B). VOLI, vascular or lymphatic invasion.

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  Fig. 4. Calibration curves of Mandard tumor regression grade (TRG) model for 3-year survival (A) and 5-year survival (B). Calibration curves of Becker TRG model for 3-year survival (C) and 5-year survival (D).

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  Fig. 5. Time-dependent receiver operating characteristic (ROC) curves of Mandard tumor regression grade (TRG) (A) and Becker TRG (B), and the areas under the ROC curve (AUC) for 1-, 3-, and 5-year survival. The p-values of the comparation between two systems were 0.513, 0.943, and 0.636 for 1, 3, and 5 years. Time-dependent ROC curves and AUC of Mandard TRG model (C) and Becker TRG model (D). The p-values of the comparation between two models were 0.584, 0.767, and 0.780 for 1, 3, and 5 years.

Reference

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