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


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.


CONCLUSIONS
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.
Department of Pathology, Research Institute and Hospital, National Cancer Center, Goyang, Korea.
Soo Hee
SH
Kim
Department of Pathology, Research Institute and Hospital, National Cancer Center, Goyang, Korea.|Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea.
Hee Jin
HJ
Chang
Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea.
Dae Yong
DY
Kim
Division of Colorectal Surgery, Department of Surgery, Seoul National University, Seoul, Korea.
Ji Won
JW
Park
Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea.
Ji Yeon
JY
Baek
Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea.
Sun Young
SY
Kim
Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea.
Sung Chan
SC
Park
Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea.
Jae Hwan
JH
Oh
Biometric Research Branch, Research Institute and Hospital, National Cancer Center, Goyang, Korea.
Ami
A
Yu
Biometric Research Branch, Research Institute and Hospital, National Cancer Center, Goyang, Korea.
Byung-Ho
BH
Nam
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001706:Biopsy; D002272:Carcinoembryonic Antigen / Q000097:blood; D002277:Carcinoma / Q000097:blood / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D059248:Chemoradiotherapy / Q000379:methods; D018572:Disease-Free Survival; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods*; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D009367:Neoplasm Staging; D011379:Prognosis; D012004:Rectal Neoplasms / Q000097:blood / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014463:Ultrasonography
D002272:Carcinoembryonic Antigen
Chemoradiotherapy; Rectal neoplasms; Tumor regression grade