Histopathologic tumor regression grading in patients with gastric carcinoma submitted to neoadjuvant treatment: results of a Delphi survey

Tsekrekos, Andrianos; Detlefsen, Sönke; Riddell, Robert H.; Conner, James; Mastracci, Luca; Sheahan, Kieran; Shetye, Jayant; Lundell, Lars; Vieth, Michael

doi:10.1016/j.humpath.2018.08.028

Cited by 26 publications

(31 citation statements)

References 29 publications

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“…In cases where no visible tumour was detected but regressive changes were present, an additional three step sections were performed similar to the approach for the primary tumour [9]. Following the recent expert recommendation by Tsekrekos et al [19] the changes had to be detected in at least one LN, regardless of the number of affected nodes. The evaluation of the histological slides was performed prospectively by an experienced gastrointestinal pathologist (KB) at the time of the sign-out of the surgical resection specimens.…”

Section: Evaluation Of Tumour Regression In Ln Metastasesmentioning

confidence: 99%

“…Regressive changes, however, can also be observed in LN metastases [11][12][13] [12,[15][16][17]. Although generally advocated by the pathologists' community [18], and suggested in a recent expert opinion paper [19], the documentation of regressive changes in LNs and LN metastases in gastric cancers is still not routinely performed. Therefore, data on this issue are available to a much lesser degree.…”

Section: Introductionmentioning

confidence: 99%

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Significance of tumour regression in lymph node metastases of gastric and gastro‐oesophageal junction adenocarcinomas

Reim

Novotny

Frieß

et al. 2020

The Journal of Pathology CR

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The presence of lymph node (LN) metastases is one of the most important negative prognostic factors in upper gastrointestinal carcinomas. Tumour regression similar to that in primary tumours can be observed in LN metastases after neoadjuvant therapy. We evaluated the prognostic impact of histological regression in LNs in 480 adenocarcinomas of the stomach and gastro-oesophageal junction after neoadjuvant chemotherapy. Regressive changes in LNs (nodular and/or hyaline fibrosis, sheets of foamy histiocytes or acellular mucin) were assessed by histology. In total, regressive changes were observed in 128 of 480 patients. LNs were categorised according to the absence or presence of both residual tumour and regressive changes (LN−/+ and Reg−/+). 139 cases were LN−/Reg−, 28 cases without viable LN metastases revealed regressive changes (LN−/Reg+), 100 of 313 cases with LN metastases showed regressive changes (LN+/Reg+), and 213 of 313 metastatic LN had no signs of regression (LN+/Reg−). Overall, LN/Reg categorisation correlated with overall survival with the best prognosis for LN−/Reg− and the worst prognosis for LN+/Reg− (p < 0.001). LN−/Reg+ cases had a nearly significant better outcome than LN+/Reg+ (p = 0.054) and the latter had a significantly better prognosis than LN+/Reg− (p = 0.01). The LN/Reg categorisation was also an independent prognostic factor in multivariate analysis (HR = 1.23; 95% CI 1.1-1.38; p < 0.001). We conclude that the presence of regressive changes after neoadjuvant treatment in LNs and LN metastases of gastric and gastrooesophageal junction cancers is a relevant prognostic factor.

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Section: Evaluation Of Tumour Regression In Ln Metastasesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Significance of tumour regression in lymph node metastases of gastric and gastro‐oesophageal junction adenocarcinomas

Reim

Novotny

Frieß

et al. 2020

The Journal of Pathology CR

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“…compared the concordance indices of four different TRGs (Mandard (three‐ and five‐category), Dworak/Rödel (three‐ and five‐category), Memorial Sloan Kettering Cancer Center (three‐category) and American Joint Committee on Cancer and College of American Pathologists (AJCC/CAP) (four‐category)) in a cohort of 563 patients with locally advanced rectal cancer, and concluded that the four‐category AJCC/CAP TRG was the most accurate and should be adopted as the standard . Six different TRG systems have been proposed so far for gastric cancer, including the results of a recent Delphi survey . Recently, a six‐tiered and a condensed three‐tiered chemotherapy response score (CRS) for tubo‐ovarian high‐grade serous carcinoma after neoadjuvant chemotherapy and interval debulking surgery has been proposed, and showed high reproducibility with a Kappa coefficient of 0.76 when using the condensed three‐tiered system …”

Section: Discussionmentioning

confidence: 99%

“…For a long time, it has been acknowledged that the degree of histological regression may provide clues to the effectiveness of chemotherapy for a given tumour. Several histological tumour regression systems (TRGs) have been developed for the quantification of 2,[27][28][29][30][31] Recently, a six-tiered and a condensed three-tiered chemotherapy response score (CRS) for tubo-ovarian high-grade serous carcinoma after neoadjuvant chemotherapy and interval debulking surgery has been proposed, and showed high reproducibility with a Kappa coefficient of 0.76 when using the condensed three-tiered system. 3,32 The tumour response of PM from colon cancer was explored in terms of tumour growth and histology in tumour-bearing rats treated with hyperthermic intraperitoneal chemotherapy.…”

Section: Discussionmentioning

confidence: 99%

Reproducibility of the peritoneal regression grading score for assessment of response to therapy in peritoneal metastasis

et al. 2019

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Aims The four‐tiered peritoneal regression grading score (PRGS) assesses the response to chemotherapy in peritoneal metastasis (PM). The PRGS is used, for example, to assess the response to pressurised intraperitoneal aerosol chemotherapy (PIPAC). However, the reproducibility of the PRGS is currently unknown. We aimed to evaluate the inter‐ and intraobserver variability of the PRGS. Methods and results Thirty‐three patients who underwent at least three PIPAC treatments as part of the PIPAC‐OPC1 or PIPAC‐OPC2 clinical trials at Odense University Hospital, Denmark, were included. Prior to each therapy cycle, peritoneal quadrant biopsies were obtained and three haematoxylin and eosin (H&E)‐stained step sections were scanned and uploaded to a pseudonymised web library. For determining interobserver variability, eight pathologists assessed the PRGS for each quadrant biopsy, and Krippendorff's alpha and intraclass correlation coefficients (ICCs) were calculated. For determining intraobserver variability, three pathologists repeated their own assessments and Cohen's kappa and ICCs were calculated. A total of 331 peritoneal biopsies were analysed. Interobserver variability for PRGS of each biopsy and for the mean and maximum PRGS per biopsy set was moderate to good/substantial. The intraobserver variability for PRGS of each biopsy and for the mean and maximum PRGS per biopsy set was good to excellent/almost perfect. Conclusions Our data support the PRGS as a reproducible and useful tool to assess response to intraperitoneal chemotherapy in PM. Future studies should evaluate the prognostic and predictive role of the PRGS.

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“…A modified Becker's system was used to assess TRG [19,20]-complete response/no residual tumor (Grade 1), subtotal regression/<10% residual tumor (Grade 2), partial regression/10-50% residual tumor (Grade 3), and no regression/>50% residual tumor (Grade 4). Assessment of TRG with this system is recommended by a panel of gastrointestinal pathology experts [20]. All patients were divided into two cohorts according to the TRG: patients with response to NAC (TRG = 1, 2, 3) and patients who did not respond to NAC (TRG = 4).…”

Section: Tumor Regression Grading After Nacmentioning

confidence: 99%

The Role of the Lymph Node Ratio in Advanced Gastric Cancer After Neoadjuvant Chemotherapy

Rawicz‐Pruszyński

Ciseł

Mlak

et al. 2019

Cancers

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The ratio of positive lymph nodes (LNs) to the total LN harvest is called the LN ratio (LNR). It is an independent prognostic factor in gastric cancer (GC). The aim of the current study was to evaluate the impact of neoadjuvant chemotherapy (NAC) on the LNR (ypLNR) in patients with advanced GC. We retrospectively analyzed the data of patients with advanced GC, who underwent gastrectomy with N1 and N2 (D2) lymphadenectomy between August 2011 and January 2019 in the Department of Surgical Oncology at the Medical University of Lublin. The exclusion criteria were a lack of preoperative NAC administration, suboptimal lymphadenectomy (

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Histopathologic tumor regression grading in patients with gastric carcinoma submitted to neoadjuvant treatment: results of a Delphi survey

Cited by 26 publications

References 29 publications

Significance of tumour regression in lymph node metastases of gastric and gastro‐oesophageal junction adenocarcinomas

Significance of tumour regression in lymph node metastases of gastric and gastro‐oesophageal junction adenocarcinomas

Reproducibility of the peritoneal regression grading score for assessment of response to therapy in peritoneal metastasis

The Role of the Lymph Node Ratio in Advanced Gastric Cancer After Neoadjuvant Chemotherapy

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