title: Pathological Assessment of the AJCC Tumor Regression Grading System After Preoperative Chemoradiotherapy for Chinese Locally Advanced Rectal Cancer.
abstract: We used American Joint Committee on Cancer (AJCC) Staging Manual system to assess the prognostic significance of tumor regression grading (TRG) for locally advanced rectal cancer (LARC) (T3/4 or N+) patients who were treated with preoperative chemoradiotherapy (CRT).The 4 AJCC-TRG classifications were evaluated on surgical specimens from 295 LARC patients receiving CRT. Overall survival (OS), disease-free survival (DFS), local recurrence-free survival (LRFS), and distant metastasis-free survival (DMFS) were estimated using Kaplan-Meier method and Cox regression model.Classifications of TRG 0, 1, 2, and 3 were found in 27.5%, 19.3%, 45.7%, and 7.5% of the resected specimens, respectively. Three-year OS was 95.5% for TRG0, 91.5% for TRG1, 84.8% for TRG2, and 85.7% for TRG3 (P = 0.035). Three-year DFS was 89.0% for TRG0, 74.4% for TRG1, 70.9% for TRG2, and 62% for TRG3 (P = 0.018). By multivariate analysis, AJCC-TRG (P = 0.033), residual lymph node metastasis (ypN+) (P < 0.001) and pretreatment CA19-9 level (P = 0.035) were significant predictors of OS. Pathological T category (P = 0.006) and nodal status (P < 0.001) after CRT were the most important independent prognostic factors for DFS.AJCC-TRG is a prognostic factor for LARC patients receiving CRT, independent of pathological staging.
authors.affiliation: From the Department of Radiation Oncology (L-NZ, W-WX, P-YOY, Z-FZ, Y-HG), Department of Colorectal Surgery (Z-ZP), Department of Medical Oncology (R-HX), and Department of Pathological Oncology (S-YX, H-ZZ), Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China; and Department of Oncology, The Second Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (K-YY).
authors.forename: Lu-Ning
authors.initials: LN
authors.lastname: Zhang
authors.forename: Wei-Wei
authors.initials: WW
authors.lastname: Xiao
authors.forename: Shao-Yan
authors.initials: SY
authors.lastname: Xi
authors.forename: Pu-Yun
authors.initials: PY
authors.lastname: OuYang
authors.forename: Kai-Yun
authors.initials: KY
authors.lastname: You
authors.forename: Zhi-Fan
authors.initials: ZF
authors.lastname: Zeng
authors.forename: Pei-Rong
authors.initials: PR
authors.lastname: Ding
authors.forename: Hui-Zhong
authors.initials: HZ
authors.lastname: Zhang
authors.forename: Zhi-Zhong
authors.initials: ZZ
authors.lastname: Pan
authors.forename: Rui-Hua
authors.initials: RH
authors.lastname: Xu
authors.forename: Yuan-Hong
authors.initials: YH
authors.lastname: Gao
mesh_terms: D000328:Adult; D000368:Aged; D044466:Asian People; D059248:Chemoradiotherapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading / Q000379:methods; D009367:Neoplasm Staging; D011300:Preoperative Care; D011379:Prognosis; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D012074:Remission Induction; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
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