TitleCollege of American Pathologists Tumor Regression Grading System for Long-term Outcome in Patients with Locally Advanced Rectal Cancer
AuthorsChen, Hai-Yang
Feng, Li-Li
Li, Ming
Ju, Huai-Qiang
Ding, Yi
Lan, Mei
Song, Shu-Mei
Han, Wei-Dong
Yu, Li
Wei, Ming-Biao
Pang, Xiao-Lin
He, Fang
Liu, Shuai
Zheng, Jian
Ma, Yan
Lin, Chu-Yang
Lan, Ping
Huang, Mei-Jin
Zou, Yi-Feng
Yang, Zu-Li
Wang, Ting
Lang, Jin-Yi
Orangio, Guy R.
Poylin, Vitaliy
Ajani, Jaffer A.
Wang, Wei-Hu
Wan, Xiang-Bo
AffiliationSun Yat Sen Univ, Affiliated Hosp 6, Dept Radiat Oncol, 26 YuanCun Er Heng Rd, Guangzhou 510655, Guangdong, Peoples R China
Guangdong Inst Gastroenterol, Guangdong Prov Key Lab Colorectal & Pelv Floor Di, Guangzhou, Peoples R China
Beijing Hosp, Natl Ctr Gerontol, Dept Radiat Oncol, Beijing, Peoples R China
Sun Yat Sen Univ, Canc Ctr, State Key Lab Oncol South China, Collaborat Innovat Ctr Canc Med, Guangzhou, Guangdong, Peoples R China
Southern Med Univ, Nanfang Hosp, Dept Radiat Oncol, Guangzhou, Guangdong, Peoples R China
Univ Elect Sci & Technol China, Radiat Oncol Key Lab Sichuan Prov, Sichuan Canc Hosp & Inst, Sch Med,Dept Radiat Oncol, Chengdu, Sichuan, Peoples R China
Univ Texas MD Anderson Canc Ctr, Dept Gastrointestinal Med Oncol, Houston, TX 77030 USA
Zhejiang Univ, Sir Run Run Shaw Hosp, Coll Med, Dept Med Oncol, Hangzhou, Zhejiang, Peoples R China
Southern Med Univ, Zhujiang Hosp, Dept Clin Skills Training Ctr, Guangzhou, Peoples R China
Sun Yat Sen Univ, Affiliated Hosp 6, Dept Gastrointestinal Surg, Guangzhou, Guangdong, Peoples R China
LSU Sch Med, LSU Dept Surg, Sect Colon & Rectal Surg, New Orleans, LA USA
Harvard Med Sch, Beth Israel Deaconess Med Ctr, Dept Surg, Div Colon & Rectum Surg, Boston, MA 02115 USA
Peking Univ, Canc Hosp & Inst, Key Lab Carcinogenesis & Translat Res, Minist Educ Beijing,Dept Radiat Oncol, 52 Fucheng Rd, Beijing 100142, Peoples R China
Issue DateFeb-2021
PublisherONCOLOGIST
AbstractBackground The National Comprehensive Cancer Network's Rectal Cancer Guideline Panel recommends American Joint Committee of Cancer and College of American Pathologists (AJCC/CAP) tumor regression grading (TRG) system to evaluate pathologic response to neoadjuvant chemoradiotherapy for locally advanced rectal cancer (LARC). Yet, the clinical significance of the AJCC/CAP TRG system has not been fully defined. Materials and Methods This was a multicenter, retrospectively recruited, and prospectively maintained cohort study. Patients with LARC from one institution formed the discovery set, and cases from external independent institutions formed a validation set to verify the findings from discovery set. Overall survival (OS), disease-free survival (DFS), local recurrence-free survival (LRFS), and distant metastasis-free survival (DMFS) were assessed by Kaplan-Meier analysis, log-rank test, and Cox regression model. Results The discovery set (940 cases) found, and the validation set (2,156 cases) further confirmed, that inferior AJCC/CAP TRG categories were closely /ccorrelated with unfavorable survival (OS, DFS, LRFS, and DMFS) and higher risk of disease progression (death, accumulative relapse, local recurrence, and distant metastasis) (all p < .05). Significantly, pairwise comparison revealed that any two of four TRG categories had the distinguished survival and risk of disease progression. After propensity score matching, AJCC/CAP TRG0 category (pathological complete response) patients treated with or without adjuvant chemotherapy displayed similar survival of OS, DFS, LRFS, and DMFS (all p > .05). For AJCC/CAP TRG1-3 cases, adjuvant chemotherapy treatment significantly improved 3-year OS (90.2% vs. 84.6%, p < .001). Multivariate analysis demonstrated the AJCC/CAP TRG system was an independent prognostic surrogate. Conclusion AJCC/CAP TRG system, an accurate prognostic surrogate, appears ideal for further strategizing adjuvant chemotherapy for LARC. Implications for Practice The National Comprehensive Cancer Network recommends the American Joint Committee of Cancer and College of American Pathologists (AJCC/CAP) tumor regression grading (TRG) four-category system to evaluate the pathologic response to neoadjuvant treatment for patients with locally advanced rectal cancer; however, the clinical significance of the AJCC/CAP TRG system has not yet been clearly addressed. This study found, for the first time, that any two of four AJCC/CAP TRG categories had the distinguished long-term survival outcome. Importantly, adjuvant chemotherapy may improve the 3-year overall survival for AJCC/CAP TRG1-3 category patients but not for AJCC/CAP TRG0 category patients. Thus, AJCC/CAP TRG system, an accurate surrogate of long-term survival outcome, is useful in guiding adjuvant chemotherapy management for rectal cancer.
URIhttp://hdl.handle.net/20.500.11897/608610
ISSN1083-7159
DOI10.1002/onco.13707
IndexedSCI(E)
Appears in Collections:北京肿瘤医院

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