Rectal tumor fragmentation as a response pattern following chemoradiation.
Rectal cancer
downstaging
neoadjuvant chemoradiation (nCRT)
tumor regression grading (TRG)
Journal
Journal of gastrointestinal oncology
ISSN: 2078-6891
Titre abrégé: J Gastrointest Oncol
Pays: China
ID NLM: 101557751
Informations de publication
Date de publication:
Dec 2022
Dec 2022
Historique:
received:
14
05
2022
accepted:
05
09
2022
entrez:
13
1
2023
pubmed:
14
1
2023
medline:
14
1
2023
Statut:
ppublish
Résumé
Tumor response to neoadjuvant therapy is heterogenous and prognostically important for locally advanced rectal adenocarcinoma (LARC) patients. Commonly applied response classification approaches including tumor regression grading (TRG) and TN downstaging can be discordant. The aim of this study is to compare the prognostic value of discordant tumor response measurement categorized according to the AJCC/CAP TRG schema and ypTN stage. This is a single-center retrospective review of 90 consecutive patients with stage II-III rectal cancer receiving neoadjuvant chemoradiation (nCRT), total mesorectal excision (TME) and adjuvant chemotherapy (ACT) between 2007 and 2018. Two pathologists re-examined each case to assign a consensus AJCC TRG. A Cox proportional hazards ratio model assessed the effect of patient, tumor, and treatment factors on disease-free survival (DFS). Median follow-up after surgery was 46 months (95% CI: 41-50 months). Median age at diagnosis was 55 years (range: 27-80). Most patients were male (58%) and Caucasian (92%) with clinical stage III disease (68%). Seventy-three patients (81%) underwent low anterior resection (LAR), 17 (19%) underwent abdominoperineal resection (APR). The median interval from completion of nCRT to surgery was 62 days (IQR: 56-70 days). The 4-year OS, DFS, and LC was 92.4%, 74.4%, and 90.2%, respectively. In the multivariate analysis, ypTN downstaging was not prognostically significant; however, AJCC TRG score 3 (minimal tumor response to treatment) was strongly predictive for inferior DFS (3-year DFS 79% Minimal tumor response to neoadjuvant therapy, AJCC TRG 3, irrespective of ypTN downstaging, is a pattern of residual disease that is at highest risk for recurrence. Response categorization discrepancies may be partly explained by alternative patterns of residual disease, including tumor fragmentation, and may be best reflected by TRG. The optimal tumor response categorization method requires further study to best stratify patient risk and management.
Sections du résumé
Background
UNASSIGNED
Tumor response to neoadjuvant therapy is heterogenous and prognostically important for locally advanced rectal adenocarcinoma (LARC) patients. Commonly applied response classification approaches including tumor regression grading (TRG) and TN downstaging can be discordant. The aim of this study is to compare the prognostic value of discordant tumor response measurement categorized according to the AJCC/CAP TRG schema and ypTN stage.
Methods
UNASSIGNED
This is a single-center retrospective review of 90 consecutive patients with stage II-III rectal cancer receiving neoadjuvant chemoradiation (nCRT), total mesorectal excision (TME) and adjuvant chemotherapy (ACT) between 2007 and 2018. Two pathologists re-examined each case to assign a consensus AJCC TRG. A Cox proportional hazards ratio model assessed the effect of patient, tumor, and treatment factors on disease-free survival (DFS).
Results
UNASSIGNED
Median follow-up after surgery was 46 months (95% CI: 41-50 months). Median age at diagnosis was 55 years (range: 27-80). Most patients were male (58%) and Caucasian (92%) with clinical stage III disease (68%). Seventy-three patients (81%) underwent low anterior resection (LAR), 17 (19%) underwent abdominoperineal resection (APR). The median interval from completion of nCRT to surgery was 62 days (IQR: 56-70 days). The 4-year OS, DFS, and LC was 92.4%, 74.4%, and 90.2%, respectively. In the multivariate analysis, ypTN downstaging was not prognostically significant; however, AJCC TRG score 3 (minimal tumor response to treatment) was strongly predictive for inferior DFS (3-year DFS 79%
Conclusions
UNASSIGNED
Minimal tumor response to neoadjuvant therapy, AJCC TRG 3, irrespective of ypTN downstaging, is a pattern of residual disease that is at highest risk for recurrence. Response categorization discrepancies may be partly explained by alternative patterns of residual disease, including tumor fragmentation, and may be best reflected by TRG. The optimal tumor response categorization method requires further study to best stratify patient risk and management.
Identifiants
pubmed: 36636056
doi: 10.21037/jgo-22-477
pii: jgo-13-06-2951
pmc: PMC9830359
doi:
Types de publication
Journal Article
Langues
eng
Pagination
2951-2962Informations de copyright
2022 Journal of Gastrointestinal Oncology. All rights reserved.
Déclaration de conflit d'intérêts
Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jgo.amegroups.com/article/view/10.21037/jgo-22-477/coif). The authors have no conflicts of interest to declare.
Références
J Natl Cancer Inst. 2017 Dec 1;109(12):
pubmed: 29206996
Ann Oncol. 2018 Jul 1;29(7):1521-1527
pubmed: 29718095
Histopathology. 2022 May;80(6):982-994
pubmed: 35352847
Dis Colon Rectum. 2012 Dec;55(12):1206-12
pubmed: 23135577
Dis Colon Rectum. 2013 Feb;56(2):142-9
pubmed: 23303141
J Clin Oncol. 2011 Aug 10;29(23):3163-72
pubmed: 21747092
Virchows Arch. 2015 May;466(5):517-23
pubmed: 25693669
J Natl Cancer Inst. 2014 Sep 22;106(10):
pubmed: 25249540
Surg Today. 2020 Aug;50(8):912-919
pubmed: 31989238
J Clin Oncol. 2012 Jun 1;30(16):1926-33
pubmed: 22529255
Radiother Oncol. 2019 Jun;135:178-186
pubmed: 31015165
Lancet Oncol. 2020 May;21(5):e252-e264
pubmed: 32359501
Clin Cancer Res. 2007 Nov 15;13(22 Pt 1):6617-23
pubmed: 18006762
Ann Surg. 2009 Oct;250(4):582-9
pubmed: 19710605
Cancer. 2008 Jul 1;113(1):57-64
pubmed: 18442099
Clin Colorectal Cancer. 2019 Jun;18(2):e231-e236
pubmed: 30772135
Hum Pathol. 2012 Nov;43(11):1917-23
pubmed: 22575264
Cancer Res Treat. 2016 Jul;48(3):998-1009
pubmed: 26511803
J Am Coll Surg. 2015 Aug;221(2):430-40
pubmed: 26206642
World J Clin Oncol. 2018 Nov 10;9(7):148-161
pubmed: 30425940
Curr Colorectal Cancer Rep. 2015;11(5):275-280
pubmed: 26321890
JAMA Netw Open. 2020 Dec 1;3(12):e2030097
pubmed: 33326026
Cancer Manag Res. 2018 Oct 31;10:5219-5225
pubmed: 30464619
In Vivo. 2020 Jan-Feb;34(1):283-289
pubmed: 31882490
J Surg Oncol. 2018 Mar;117(4):737-744
pubmed: 29228455
Cancer Treat Rev. 2020 Mar;84:101964
pubmed: 32000055
J Clin Oncol. 2009 Nov 1;27(31):5124-30
pubmed: 19770376
Lancet Oncol. 2010 Sep;11(9):835-44
pubmed: 20692872
Cancers (Basel). 2018 Sep 07;10(9):
pubmed: 30205529
Lancet Oncol. 2021 Jul;22(7):e314-e326
pubmed: 34048686
J Clin Oncol. 2005 Dec 1;23(34):8688-96
pubmed: 16246976
Sci Rep. 2016 Oct 10;6:34923
pubmed: 27721486
Colorectal Dis. 2014 Aug;16(8):610-5
pubmed: 24593015
Colorectal Dis. 2021 Jun;23(6):1326-1333
pubmed: 33394572
Arch Med Res. 2003 Jul-Aug;34(4):281-6
pubmed: 12957524
Int J Colorectal Dis. 1997;12(1):19-23
pubmed: 9112145
In Vivo. 2020 Jul-Aug;34(4):1993-1999
pubmed: 32606172
J Surg Oncol. 2014 Jun;109(8):853-8
pubmed: 24862927
Cancer. 1994 Jun 1;73(11):2680-6
pubmed: 8194005
Dis Colon Rectum. 2015 Jan;58(1):32-44
pubmed: 25489692