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The prognostic value of tumour regression grade following neoadjuvant chemoradiation therapy for rectal cancer
Author(s) -
AbdulJalil K. I.,
Sheehan K. M.,
Kehoe J.,
Cummins R.,
O'Grady A.,
McNamara D. A.,
Deasy J.,
Breathnach O.,
Grogan L.,
O'Neill B. D. P.,
Faul C.,
Parker I.,
Kay E. W.,
Hennessy B. T.,
Gillen P.
Publication year - 2014
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/codi.12439
Subject(s) - medicine , colorectal cancer , neoadjuvant therapy , grading (engineering) , cohort , lymph node , pathological , multivariate analysis , oncology , cancer , gastroenterology , civil engineering , breast cancer , engineering
Aim To date, there is no uniform consensus on whether tumour regression grade ( TRG ) is predictive of outcome in rectal cancer. Furthermore, the lack of standardization of TRG grading is a major source of variability in published studies. The aim of this study was to evaluate the prognostic impact of TRG in a cohort of patients with locally advanced rectal cancer treated with neoadjuvant chemoradiation therapy ( CRT ). In addition to the M andard TRG , we utilized four TRG systems modified from the M andard TRG system and applied them to the cohort to assess which TRG system is most informative. Method One‐hundred and fifty‐three patients with a T3/T4 and/or a node‐positive rectal cancer underwent neoadjuvant 5‐fluorouracil‐based CRT followed by surgical resection. Results Thirty‐six (23.5%) patients achieving complete pathological response (yp CR ) had a 5‐year disease‐free survival ( DFS ) rate of 100% compared with a DFS rate of 74% for 117 (76.5%) patients without yp CR ( P = 0.003). The Royal College of Pathologists ( RCP ath) TRG best condenses the M andard five‐point TRG by stratifying patients into three groups with distinct 5‐year DFS rates of 100%, 86% and 67%, respectively ( P = 0.001). In multivariate analysis, pathological nodal status and circumferential resection margin ( CRM ) status, but not TRG , remained significant predictors of DFS ( P = 0.002, P = 0.035 and P = 0.310, respectively). Conclusion Our findings support the notion that yp CR status, nodal status after neoadjuvant CRT and CRM status, but not TRG , are predictors of long‐term survival in patients with locally advanced rectal cancer.