Neoadjuvant chemoradiation for patients with advanced oesophageal cancer – which response grading system best impacts prognostic discrimination?

Abstract

Aims Neoadjuvant chemoradiation reduces tumour volume and improves the R0 resection rate, followed by extended survival for patients with advanced oesophageal cancer. The degree of tumour regression has high prognostic relevance. To date, there is still no generally accepted tumour regression grading system. The aim of this study was to compare the prognostic discrimination power of different histological regression grading systems: (i) the fibrosis/tumour ratio within the primary tumour (Mandard classification), (ii) the percentage of residual vital tumour cells (VTC) compared to the original primary tumour (Cologne Regression) and (iii) the ypT category, in patients with cT3 carcinoma of the oesophagus after neoadjuvant chemoradiation. Methods and results This study included 216 patients with oesophageal cancer clinically staged as cT3NxM0 and treated from 2009 to 2012 with standardised chemoradiation followed by oesophagectomy [median age 62 years, 176 (81%) male and 138 (64%) adenocarcinoma patients]. The subgroup frequencies of the three classification systems were ypT category: ypT0 = 18%, ypT1 = 14%, ypT2 = 23%, ypT3 = 44%, ypT4 = 1%; Mandard classification: TRG1 = 18%, TRG2 = 26%, TRG3 = 24%, TRG4 = 30%, TRG5 = 2%; and Cologne Regression Scale: no tumour = 18%, 1–10% VTC = 27%, 10–50% VTC = 26% and >50% VTC = 29%. The Mandard and Cologne Regression classifications showed better prognostic differentiation for the subgroups than the ypT category. The four‐tiered Cologne Regression system had a good prognostic relevance. Comparing results of the re‐evaluated Cologne Regression classification with the classification by routine pathological report showed very good inter‐rater agreement, with kappa value 0.891. Conclusion Compared to the original primary tumour, the tumour regression grading system using the percentage of residual vital tumour has prognostic relevance.

Evaluation and Comparison of Predictive Value of Tumor Regression Grades according to Mandard and Becker in Locally Advanced Gastric Adenocarcinoma

“…For the Mandard TRG, some studies supported that TRG 1-2 should be classified into responders, which was in accordance with our study [7,18,19], while some others believed that TRG 1-3 was better in distinguishing the prognosis [20][21][22]. For the Becker TRG, there were studies supporting the same consequence as ours [1,[23][24][25], while others suggested TRG 1-2 owned a better prognosis than TRG 3 [9,10,26,27]. This discrepancy might partly derive from the differences in subjective evaluations of the pathologists.…”

Esophageal Carcinoma Cuniculatum Diagnosed on Mucosal Biopsies Using a Semiquantitative Histologic Schema: Report of Two Esophagectomy-Confirmed Cases

“…The mechanism leading to this phenomenon is likely the death of chemoradiation-sensitive cells in the basal layer of the cysts/furrows leading to exposure of luminal keratinous material which incites a strong histiocytic and giant cell response. Tumor regression in the esophagectomy specimen in patients who receive neoadjuvant chemoradiation is prognostic [9]. Tumor regression in carcinoma cuniculatum is difficult to assess as distinguishing dyskeratotic/apoptotic cells from terminally differentiated but viable cells is difficult.…”

Tumor Regression Grade Predicts Survival in Locally Advanced Gastric Adenocarcinoma Patients with Lymph Node Metastasis

“…Except for the status of lymph node, other pathological factors including T stage [ 8 , 22 , 23 ], the Lauren classification [ 22 , 27 ], the grade of differentiation [ 11 , 22 ], and tumor type [ 28 , 29 ] were also considered to correlate with TRG, which might affect the significance of this system. More studies are needed to investigate if the TRG system would show different significance on prognosis in patients with various clinicopathological characteristics.…”