Prognostic significance of tumour regression grade after neoadjuvant chemoradiotherapy for a cohort of patients with locally advanced rectal cancer: an 8‐year retrospective single‐institutional study

Xu, Lai; Cai, Songhua; Xiao, Tixian; Chen, Yanyu; Qiu, Huizhong; Wu, Bin; Lin, Guole; Sun, Xian; Lu, Junliang; Zhou, Weixun; Xiao, Yi

doi:10.1111/codi.13757

Cited by 18 publications

(28 citation statements)

References 27 publications

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“…The pathological lymph node status in surgical specimens was recognized as one of the pivotal factors predicting oncological outcomes in patients with rectal cancer treated with surgery alone [12,29,30], and our observation revealed the potential for the same predictor for recurrence between short-course RT with immediate surgery and surgery alone. In contrast, some evidence suggested that the tumor regression grade system could be a more powerful predictor than ypTNM stage classification for predicting oncological prognosis in rectal cancer patients receiving long-course CRT [31,32]. Consistent with previous evidence, our study also showed that pathological response for CRT was one of the independent predictive factors of recurrence in rectal cancer patients following long-course CRT.…”

Section: Discussionsupporting

confidence: 90%

Identification of Predictors of Recurrence in Patients with Lower Rectal Cancer Undergoing Neoadjuvant Chemotherapy: A Direct Comparison of Short-Course and Long-Course Chemoradiotherapy

et al. 2018

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Objective: This study aimed to investigate clinicopathological responses and oncological outcome in patients receiving short- or long-course chemoradiotherapy (CRT) and to assess the predictive factor for recurrence in each treatment. Methods: A total of 118 rectal cancer patients receiving preoperative CRT were enrolled. Clinicopathological responses and oncological outcome in patients receiving short- or long-course CRT were investigated. Results: Despite there being no significant differences in the prognosis of disease-free survival (DFS) based on TNM stage classification in patients receiving long-course CRT, patients with advanced stage demonstrated poor DFS after short-course CRT. The presence of lymph node metastasis was a predictor of poor DFS in short-course CRT, whereas poor pathological response was a predictor of recurrence in long-course CRT. Conclusions: Distinct predictors of recurrence depending on the CRT course might be needed to discriminate candidates from rectal cancer patients receiving preoperative CRT who might benefit from more intensive adjuvant therapy after surgery.

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Section: Discussionsupporting

confidence: 90%

Identification of Predictors of Recurrence in Patients with Lower Rectal Cancer Undergoing Neoadjuvant Chemotherapy: A Direct Comparison of Short-Course and Long-Course Chemoradiotherapy

et al. 2018

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“…Histological tumor response to preoperative treatment can be evaluated as tumor regression grade (TRG). In LARC treated with NCRT, TRG is a significant predictive factor for outcome …”

Section: Responsive Indicators Among Patients Receiving Ncrtmentioning

confidence: 99%

“…In LARC treated with NCRT, TRG is a significant predictive factor for outcome. 60 Serum carcinoembryonic antigen (CEA) is currently the most widely used tumor marker, especially in CRC. 61 Several studies have investigated the utility of pre-and post-CRT CEA concentrations as predictors of response to NCRT.…”

Section: Responsive Indicators Among Patients Receiving Ncrtmentioning

confidence: 99%

Surgical treatment following neoadjuvant chemoradiotherapy in locally advanced rectal cancer

Huang

Wang

2019

The Kaohsiung J of Med Scie

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Colorectal cancer is a major public health problem worldwide, and locally advanced rectal cancer (LARC) is known for its poor prognosis. A multimodal treatment approach is the only method to achieve satisfactory local recurrence and survival rates in LARC. Determining which therapeutic modality for LARC has the most satisfactory influence on quality of life and disease outcome is still controversial. LARC treatment is subject to continuous advancement due to the development of new and better diagnostic tools, radiotherapy techniques, and chemotherapeutic agents. Herein, we review various therapeutic modalities for LARC from several aspects. In addition to radiotherapy techniques such as neoadjuvant chemoradiotherapy (NCRT), we discuss the progress of chemotherapy, appropriate time interval between NCRT and surgery, relationship between tumor location and NCRT efficacy/safety, wait‐and‐watch policy, and predictors of treatment response following NCRT. Because of the controversies and unanswered questions regarding NCRT treatments for LARC, additional investigations are required to determine which therapeutic approach is the most feasible for LARC patients.

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“…The need for treatment discontinuation in our study (17.6% of patients receiving 5-FU plus oxaliplatin) was also similar to that reported previously. pCR [10][11][12] and PNI are both well-known prognostic markers in rectal cancer. In the present study, in addition to aCT, the multivariate analysis identified pCR as a marker of longer DFS (HR 0.10; p = 0.03) but not of OS, and PNI as a marker of shorter DFS (HR 3.36; p < 0.001) and OS (HR 2.85; p = 0.02).…”

Section: Discussionmentioning

confidence: 99%

“…Several scores have been proposed for risk stratification of LARC patients 8,9 , most of which are based on analysis of the surgical tumor sample. The factors with high prognostic value include pathological complete response (pCR) [10][11][12] and perineural invasion (PNI) 13 . In contrast, few risk scores include baseline patient characteristics, partially due to the limitations of diagnostic techniques, especially regarding lymph node involvement 14 .…”

Section: Introductionmentioning

confidence: 99%

Adjuvant Chemotherapy in Locally Advanced Rectal Cancer: Deciding on the Optimal Strategy

Torres-Olombrada

Juez-Martel

Rodríguez-Caravaca

et al. 2020

RIC

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Background: Neoadjuvant therapy, followed by surgery, reduces the risk of local relapse in rectal cancer, but approximately 30% will relapse with distant metastases, highlighting the importance of adjuvant chemotherapy (aCT). Objective: The objective of the study was to study two regimens of adjuvant treatment in patients with locally advanced rectal cancer and analyze their efficacy and toxicity. Methods: Between January 2009 and December 2016, 193 patients with Stage II-III rectal cancer who had received neoadjuvant therapy were included by consecutive non-probability sampling. The decision to administer aCT, as well as the specific regimen, was at the discretion of the medical oncologist. Disease-free survival (DFS) and overall survival (OS) were calculated. Results: The mean DFS was 84.85 (95% confidence interval [CI]: 79-90) months in 164 patients receiving aCT, compared to 57.71 (95% CI: 40-74) months in 29 who did not receive aCT (p < 0.001). Then, mean OS was 92.7 (95% CI: 88-97) months and 66.18 (95% CI 51-81) months, respectively (p < 0.001). DFS was 83.6 (95% CI: 76-91) months in 74 patients receiving adjuvant 5-fluorouracil (5-FU), and 82.9 (95% CI: 75-90) months in 90 receiving 5-FU plus oxaliplatin (p = 0.49). OS was 87 (95% CI: 80-94) versus 93.65 (95% CI: 88-99) months, respectively (p = 0.76). The multivariate analysis identified aCT hazard ratio (HR) 0.30 (95% CI: 0.1-0.46), perineural invasion HR 3.36 (95% CI: 1.7-6.5), and pathological complete response HR 0.10 (95% CI: 0.01-0.75) as independent markers of DFS. Conclusions: In our study, aCT was associated with longer DFS and OS. 5-FU plus oxaliplatin showed greater toxicity with no added benefit in DFS or OS.

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Prognostic significance of tumour regression grade after neoadjuvant chemoradiotherapy for a cohort of patients with locally advanced rectal cancer: an 8‐year retrospective single‐institutional study

Abstract: TRG measured on a five-tier system was better than ypTNM stage for predicting outcome in patients with LARC treated with NACRT and surgery.

Cited by 18 publications

References 27 publications

Identification of Predictors of Recurrence in Patients with Lower Rectal Cancer Undergoing Neoadjuvant Chemotherapy: A Direct Comparison of Short-Course and Long-Course Chemoradiotherapy

Identification of Predictors of Recurrence in Patients with Lower Rectal Cancer Undergoing Neoadjuvant Chemotherapy: A Direct Comparison of Short-Course and Long-Course Chemoradiotherapy

Surgical treatment following neoadjuvant chemoradiotherapy in locally advanced rectal cancer

Adjuvant Chemotherapy in Locally Advanced Rectal Cancer: Deciding on the Optimal Strategy

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