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

Wang, Yi; Xu, Handong; Hu, Can; Yu, Pengcheng; Bao, Zhehan; Zhang, Yanqiang; Zhang, Ruolan; Zhang, Shengjie; Li, Bing; Aerts, Jean‐Marie; Xu, Zhiyuan; Cheng, Xiangdong

doi:10.21037/jgo-22-537

Cited by 12 publications

(10 citation statements)

References 22 publications

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“…We selected a total of 92 patients whose pathological findings included tumor regression grade (TRG). According to the Mandard TRG criteria, marked TRG 1–3 as a good pathological response was contrasted with TRG 4 or 5 as a poor pathological response [ 30 ]. 47.82% (44/92) of patients were assessed as TRG 1 (pathological complete response, pCR), 14.13% (13/92) as TRG 2, 16.30% (15/92) as TRG 3, 15.22% (14/92) as TRG 4, and 5.43% (6/92) as TRG 5.…”

Section: Resultsmentioning

confidence: 99%

Dynamic radiological features predict pathological response after neoadjuvant immunochemotherapy in esophageal squamous cell carcinoma

Ruan,

Ma,

et al. 2024

J Transl Med

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Background Neoadjuvant immunochemotherapy (NICT) plus esophagectomy has emerged as a promising treatment option for locally advanced esophageal squamous cell carcinoma (LA-ESCC). Pathologic complete response (pCR) is a key indicator associated with great efficacy and overall survival (OS). However, there are insufficient indicators for the reliable assessment of pCR. Methods 192 patients with LA-ESCC treated with NICT from December 2019 to October 2023 were recruited. According to pCR status, patients were categorized into pCR group (22.92%) and non-pCR group (77.08%). Radiological features of pretreatment and preoperative CT images were extracted. Logistic and COX regressions were trained to predict pathological response and prognosis, respectively. Results Four of the selected radiological features were combined to construct an ESCC preoperative imaging score (ECPI-Score). Logistic models revealed independent associations of ECPI-Score and vascular sign with pCR, with AUC of 0.918 in the training set and 0.862 in the validation set, respectively. After grouping by ECPI-Score, a higher proportion of pCR was observed among the high-ECPI group and negative vascular sign. Kaplan Meier analysis demonstrated that recurrence-free survival (RFS) with negative vascular sign was significantly better than those with positive (P = 0.038), but not for OS (P = 0.310). Conclusions This study demonstrates dynamic radiological features are independent predictors of pCR for LA-ESCC treated with NICT. It will guide clinicians to make accurate treatment plans.

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Section: Resultsmentioning

confidence: 99%

Dynamic radiological features predict pathological response after neoadjuvant immunochemotherapy in esophageal squamous cell carcinoma

Ruan,

Ma,

et al. 2024

J Transl Med

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“…For digestive cancers, including GC, but not for stage IV cancers, Tao Wan et al concluded that pCR correlates with favorable survival outcomes compared to non-pCR after surgery following chemotherapy [ 14 ]. Furthermore, for patients who successfully underwent surgery after chemotherapy, achieving pCR emerged as an independent prognostic factor, with a 3-year overall survival (OS) of 70.9%, surpassing the 48.8% OS of patients who did not achieve pCR after conversion surgery [ 15 ]. TRG (tumor regression grade (TRG) could also be an independent prognostic factor affecting the OS of GC patients [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, for patients who successfully underwent surgery after chemotherapy, achieving pCR emerged as an independent prognostic factor, with a 3-year overall survival (OS) of 70.9%, surpassing the 48.8% OS of patients who did not achieve pCR after conversion surgery [ 15 ]. TRG (tumor regression grade (TRG) could also be an independent prognostic factor affecting the OS of GC patients [ 15 ]. These results suggest that even if chemotherapy is not completely effective, a greater efficacy is still associated with better prognosis.…”

Section: Discussionmentioning

confidence: 99%

Conversion surgery for gastric remnant cancer with liver metastasis after nivolumab combination chemotherapy achieving pathological complete response: a case report and literature review

Katsumata,

Morimoto,

Aoyama

et al. 2024

surg case rep

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Background Nivolumab combination chemotherapy has recently emerged as a potential first-line treatment for patients with unresectable or metastatic gastric cancer (GC). Further research has indicated that R0 resection by conversion surgery could be an effective treatment strategy to improve overall survival. However, there have been limited reports on the successful application of conversion surgery following combination chemotherapy achieving pathological complete response (pCR) in cases of advanced gastric remnant cancer with liver metastasis. Here, we present a case of long-term survival in a patient who underwent this treatment. Case presentation A 54-year-old man was initially referred to our department for treatment of stage III (cT3N1M0) gastric cancer where he underwent laparoscopic distal gastrectomy and D2 lymph node dissection. After a year of uneventful follow-up, the patient was diagnosed with a tumor in the gastric remnant combined with liver metastasis, resulting in a diagnosis of stage IV (cT3N0M1) gastric remnant cancer. Subsequently, the patient was treated with four cycles of TS-1, Oxaliplatin, and Nivolumab as the first-line regimen. Remarkably, both the remnant tumor and liver metastasis exhibited significant shrinkage, and no new lesions were found. Given this response, conversion surgery was performed to achieve complete resection of the remnant gastric cancer and liver metastasis, followed by laparoscopic remnant gastrectomy and partial hepatectomy. Pathological examination revealed the absence of residual carcinoma cells and lymph node metastases. Postoperatively, the patient was treated with adjuvant chemotherapy with S-1 for 1 year, and survived without recurrence for 18 months after conversion surgery. Conclusions Nivolumab combination chemotherapy shows promise as a clinically beneficial treatment approach for gastric remnant cancer with liver metastasis, particularly when pCR can be achieved following conversion surgery.

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“…However, there is currently no unified standard for evaluating neoadjuvant treatment response and many authors have proposed various methods, including pathological tumor regression assessed by the TRG system, radiological tumor regression according to RECIST version 1.1 and serum tumor marker [ 5 , 6 , 13 ]. A retrospective study conducted by Wang et al found that TRG (P = 0.042, HR = 1.65) was an independent prognostic factor affecting the OS of GC patients, and patients who had a pathological response to NAT had a better prognosis [ 14 ]. Pietro et al analyzed 67 LAGC patients who had received preoperative chemotherapy and found that clinical response was a prognostic factor for both OS and DFS (OS:P = 0.003; DFS: P = 0.003) [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

Concurrent clinical and pathological response predicts favorable prognosis of patients with gastric cancer after neoadjuvant therapy: a real-world study

Sun,

Niu,

Zhang

et al. 2023

BMC Cancer

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Background Response of locally advanced gastric cancer (LAGC) to neoadjuvant therapy (NAT) may be associated with prognosis, but which of the clinical or pathological evaluation can accurately predict a favorable prognosis is still controversial. This study aims to compare the effect of clinical and pathological response on the prognosis of patients with gastric cancer. Methods This study retrospectively analyzed LAGC patients who underwent NAT followed by surgery in the China National Cancer Center from January 2004 to January 2021. Clinical and pathological responses after NAT were evaluated using RECIST 1.1 and Mandard tumor regression grade system (TRG) respectively. Complete response (CR) and partial response (PR) assessed by computed tomography were regarded as clinical response. For histopathology regression assessment, response was defined as Mandard 1, 2, 3 and non-response as Mandard 4, 5. Furthermore, we combined clinical and pathological evaluation results into a variable termed “comprehensive assessment” and divided it into four groups based on the presence or absence of response (concurrent response, only clinical response, only pathological response, both non-response). The association between the prognosis and clinicopathological factors was assessed in univariate and multivariate Cox regression analysis. Results In total, 238 of 1073 patients were included in the study after screening. The postoperative pathological response rate and clinical response rate were 50.84% (121/238) and 39.92% (95/238), respectively. 154 patients got consistent results in clinical and pathological evaluation (66 were concurrent response and 88 were both non-response), while the other 84 patients did not. The kappa value was 0.297(p < 0.001), which showed poor consistency. Multivariate Cox regression analysis revealed that comprehensive assessment (P = 0.03), clinical N stage(P < 0.001), vascular or lymphatic invasion (VOLI) (HR 2.745, P < 0.001), and pre-CA724(HR 1.577, P = 0.047) were independent factors for overall survival in patients with gastric cancer. Among four groups in the comprehensive assessment, concurrent response had significantly better survival (median OS: 103.5 months) than the other groups (P = 0.008). Conclusion Concurrent clinical and pathological response might predict a favorable prognosis of patients with gastric cancer after neoadjuvant therapy, further validation is needed in prospective clinical trials with larger samples.

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

Cited by 12 publications

References 22 publications

Dynamic radiological features predict pathological response after neoadjuvant immunochemotherapy in esophageal squamous cell carcinoma

Dynamic radiological features predict pathological response after neoadjuvant immunochemotherapy in esophageal squamous cell carcinoma

Conversion surgery for gastric remnant cancer with liver metastasis after nivolumab combination chemotherapy achieving pathological complete response: a case report and literature review

Concurrent clinical and pathological response predicts favorable prognosis of patients with gastric cancer after neoadjuvant therapy: a real-world study

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