title: Prognostic value of mandard and dworak tumor regression grading in rectal cancer: study of a single tertiary center.
abstract: Goal. To evaluate the prognostic value of Mandard and Dworak grading systems regarding neoadjuvant chemoradiotherapy (CRT) response on rectal cancer. Materials and Methods. We queried our center's database for patients with colo rectal cancer with locally advanced rectal cancer (LARC) who received neoadjuvant CRT followed by total mesorectum excision (TME) between 2003 and 2011. After excluding 18 patients from the initial query the remaining 139 were reassessed for disease recurrence and survival; the specimens' slides were reviewed and classified according to two tumor regression grading (TRG) systems: Mandard and Dworak. Based on these TRG scores, two patient groups were created: patients with good response versus patients with bad response (Mandard TRG1+2 versus Mandard TRG3+4+5 and Dworak TRG4+3 versus Dworak TRG2+1+0). Overall survival (OS), disease-free survival (DFS), and disease recurrence were then evaluated. Results. Mean age was 64.2 years and median follow up was 56 months. No significant survival difference was found when comparing patients with Dworak TRG 4+3 versus Dworak TRG2+1+0 (P = 0.10). Mandard TRG1+2 presented with significantly better OS and DFS than Mandard TRG3+4+5 (OS P = 0.013; DFS P = 0.007). Conclusions. Mandard system provides higher accuracy over Dworak system in predicting rectal cancer prognosis when neoadjuvant CRT is applied for tumor regression.
authors.affiliation: Department of Surgery, Digestive Surgery Service, Hospital de Santo António, Largo Professor Abel Salazar, 4099-003 Porto, Portugal.
authors.forename: Marisa D
authors.initials: MD
authors.lastname: Santos
authors.affiliation: Department of Surgery, Digestive Surgery Service, Hospital de Santo António, Largo Professor Abel Salazar, 4099-003 Porto, Portugal.
authors.forename: Cristina
authors.initials: C
authors.lastname: Silva
authors.affiliation: Department of Surgery, Digestive Surgery Service, Hospital de Santo António, Largo Professor Abel Salazar, 4099-003 Porto, Portugal.
authors.forename: Anabela
authors.initials: A
authors.lastname: Rocha
authors.affiliation: Department of Community Health, Instituto de Ciências Biomédicas Abel Salazar, Rua Jorge Viterbo Ferreira No. 228, 4050-313 Porto, Portugal.
authors.forename: Eduarda
authors.initials: E
authors.lastname: Matos
authors.affiliation: Department of Surgery, Digestive Surgery Service, Hospital de Santo António, Largo Professor Abel Salazar, 4099-003 Porto, Portugal.
authors.forename: Carlos
authors.initials: C
authors.lastname: Nogueira
authors.affiliation: Department of Pathology, Pathological Anatomy Service, Hospital de Santo António, Largo Professor Abel Salazar, 4099-003 Porto, Portugal ; Department of Pathology and Molecular Immunology, Instituto de Ciências Biomédicas Abel Salazar, Rua Jorge Viterbo Ferreira No. 228, 4050-313 Porto, Portugal.
authors.forename: Carlos
authors.initials: C
authors.lastname: Lopes
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