Impact of tumor regression grade on recurrence after preoperative chemoradiation and gastrectomy for gastric cancer

Stark, Alexander P.; Estrella, Jeannelyn S.; Chiang, Yi Ju; Das, Prajnan; Minsky, Bruce D.; Murphy, Mariela A. Blum; Ajani, Jaffer A.; Mansfield, Paul F.; Badgwell, Brian D.; Ikoma, Naruhiko

doi:10.1002/jso.25984

Cited by 9 publications

(4 citation statements)

References 34 publications

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“…At present, the role of the TRG in predicting prognosis is controversial and inconclusive. Stark et al (21) reviewed 247 patients with gastric adenocarcinoma who received chemotherapy or chemoradiotherapy combined with surgical resection and found that the TRG was not associated with recurrence-free survival (RFS), local recurrence (LR), or distant recurrence (DR) by using the percentage of surviving tumor cells in the specimen to represent the TRG. Furthermore, Blackham et al conducted a TRG study on 58 GC patients from two institutional databases and also found that TRG was not an independent factor affecting the survival prognosis of patients (11).…”

Section: Discussionmentioning

confidence: 99%

Prognostic value and clinicopathological correlation of the tumor regression grade in neoadjuvant chemotherapy for gastric adenocarcinoma: a retrospective cohort study

Wang¹,

Xu²,

Hu³

et al. 2022

J Gastrointest Oncol

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Background: Neoadjuvant chemotherapy (NACT) and radical gastrectomy are the gold standard treatments for resectable advanced gastric cancer (GC). However, the prognostic value of the pathological tumor regression grade (TRG) of NACT remains controversial. This retrospective study aimed to investigate the correlation between the TRG after NACT and clinicopathological features as well as its prognostic value in advanced GC. Methods: In total, 551 patients with GC who received NACT combined with surgical resection at the Zhejiang Cancer Hospital from April 2004 to December 2019 were included. The demographic characteristics, treatment response, tumor characteristics, treatment regimens, and survival data were reviewed from the medical records of all patients. The Chi-square test was used to analyze the correlation between TRG and clinicopathological factors. Kaplan-Meier univariate analysis and Cox regression multivariate analysis were used to determine the independent risk factors affecting the prognosis of GC patients.Results: Among the 551 patients with advanced GC who accepted NACT treatment, 14 were determined to be in TRG 0, 98 in TRG 1, 257 in TRG 2, and 182 in TRG 3. Also, TRG was significantly correlated with the cT stage (P=0.015), ypT stage (P<0.001), ypN stage (P<0.001), ypTNM stage (P<0.001), vascular tumor thrombus (P<0.001), Borrmann classification (P=0.042), and lymph node ratio (LNR) (P<0.001). Furthermore, patients who had a good pathological response to NACT had a better prognosis, with a 3-year overall survival (OS) of 70.9% versus 48.8% in patients who had a poor pathological response. We also found that TRG (P=0.042, HR =1.65) was an independent prognostic factor affecting the OS of GC patients.Conclusions: TRG plays a significant role in the prognostic value in neoadjuvant chemotherapy for gastric adenocarcinoma. Patients with higher cT stage, higher levels of pre-CA199 and pre-CA125 may have worse pathological response.

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Section: Discussionmentioning

confidence: 99%

Prognostic value and clinicopathological correlation of the tumor regression grade in neoadjuvant chemotherapy for gastric adenocarcinoma: a retrospective cohort study

Wang¹,

Xu²,

Hu³

et al. 2022

J Gastrointest Oncol

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“…Due to the currently limited preoperative therapies and the limited number of responsive patients, findings on the value of TRG prognostic systems in LAGC are varied. Additional complexities arise when the study contexts are based on different TRG systems, especially on the comparison between TRG and ypTNM systems as independent predictors of patients survival[ 24 - 29 ]. Becker et al [ 16 ] investigated 480 patients with LAGC undergoing surgical resection and found TRG 2-3 grade (10%-100% residual tumor) to be an independent risk factor for patient OS; this reinforced the efficacy of the Becker TRG system.…”

Section: Discussionmentioning

confidence: 99%

Comparison of tumor regression grading systems for locally advanced gastric adenocarcinoma after neoadjuvant chemotherapy

Liu¹,

Wang²,

Zhang³

et al. 2021

WJGO

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BACKGROUND Current tumor regression grade (TRG) evaluations are based on various systems which brings confusion for oncologists and pathologists when interpreting results. The recent six-tier system (JGCA2017-TRG) recommended by the Japanese Gastric Cancer Association (JGCA) is worth investigating, as four-tier TRG systems are favored in various parts of the world. AIM To compare the predictive accuracies of five published TRG systems. METHODS Data were retrospectively collected from patients with locally advanced gastric cancer (LAGC) who underwent neoadjuvant chemotherapy followed by D2 Lymphadenectomy between January 2005 and January 2014 at our institution. Outcomes were overall survival (OS) and disease-free survival (DFS), which were evaluated separately using the following TRG systems: JGCA2017, JGCA, Becker, AJCC/CAP, and Mandard. RESULTS All five published TRG systems were independent predictors for OS and DFS. Concordance indices of the JGCA2017, JGCA, Becker, AJCC/CAP-TRG, and Mandard systems were 0.651/0.648 0.652/0.649, 0.693/0.695, 0.688/0.685, and 0.674/0.675 for OS and DFS, respectively. The four-tier Becker system showed the highest c-index, which was significantly greater than that of the six-tier JGCA2017 and five-tier JGCA systems ( P < 0.05 in OS and DFS). When residual tumor percentages were reset as: “no residual tumor”, < 10%, < 100%, and “no response”, the rearranged cutoff values achieved a maximum c-index with 0.728 for OS and 0.737 for DFS, which was superior to the other five systems. CONCLUSION The newly introduced six-tier JGCA-TRG system cannot increase prognostic stratification. The four-tier Becker system is more suitable for LAGC patients. A population-based study is warranted to define the optimal criterion for TRG in LAGC patients.

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“…This study applied the National Comprehensive Cancer Network (NCCN) classification system to assess the tumor regression grade (TRG). TRG was defined by the percentage of viable cancer cells in the resected primary tumor: TRG 0 = complete response, no viable tumor cells including lymph nodes; TRG 1 = near complete response, single cancer cells or rare small groups of cells; TRG 2 = partial response, residual tumor cells with obvious tumor regression but the amount of cancer cells is more than that in TRG 1; TRG 3 = poor or no response, extensive residual cancer with no evident tumor regression [ 13 , 14 ]. According to previous studies, pathological response was defined as TRG = 0 or 1 [ 15 ].…”

Section: Methodsmentioning

confidence: 99%

Comparison of response evaluation criteria in solid tumors and tumor regression grade in evaluating the effect of preoperative systemic therapy of gastric cancer

et al. 2022

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Background Both Response Evaluation Criteria in Solid Tumors (RECIST) and tumor regression grade (TRG) play key roles in evaluating tumor response. We analyzed the consistency of TRG and RECIST 1.1 for gastric cancer (GC) patients and compared their prognostic values. Methods Patients with GC who received preoperative chemotherapy or chemoimmunotherapy and had records of TRG from December 2013 to October 2021 were enrolled retrospectively. TRG 0–1 and 2–3 are considered as corresponding to complete response (CR)/partial response (PR) and stable disease (SD)/progress disease (PD) in RECIST 1.1, respectively. The primary endpoints were disease-free survival (DFS) and overall survival (OS). The consistency of RECIST and TRG was examined by kappa statistics. Survival analysis was performed using the Kaplan Meier method. Result One hundred fifty seven GC patients were enrolled, including 125 with preoperative chemotherapy and 32 with chemoimmunotherapy. Among them, 56 patients had measurable lesions. Only 19.6% (11/56) of the patients had consistent results between RECIST 1.1 and TRG. TRG was correlated with both OS and DFS (P = 0.02 and 0.03, respectively) while response according to RECIST1.1 was not (P = 0.86 and 0.23, respectively). The median DFS had not reached in the TRG 0–1 group and was 16.13 months in TRG 2–3 group. TRG 2–3 was associated with young age and peritoneal or liver metastasis. Besides, preoperative chemoimmunotherapy had a significantly higher pCR rate than chemotherapy alone (34.4% vs 8.0%, P < 0.001). Conclusion TRG was in poor agreement with RECIST 1.1. TRG was better than RECIST 1.1 in predicting DFS and OS for GC patients who received preoperative therapy.

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Impact of tumor regression grade on recurrence after preoperative chemoradiation and gastrectomy for gastric cancer

Cited by 9 publications

References 34 publications

Prognostic value and clinicopathological correlation of the tumor regression grade in neoadjuvant chemotherapy for gastric adenocarcinoma: a retrospective cohort study

Prognostic value and clinicopathological correlation of the tumor regression grade in neoadjuvant chemotherapy for gastric adenocarcinoma: a retrospective cohort study

Comparison of tumor regression grading systems for locally advanced gastric adenocarcinoma after neoadjuvant chemotherapy

Comparison of response evaluation criteria in solid tumors and tumor regression grade in evaluating the effect of preoperative systemic therapy of gastric cancer

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