Prognostic value of tumour regression grade in locally advanced rectal cancer: a systematic review and meta‐analysis

Kong, Joseph; Guerra, Glen R; Warrier, Satish; Lynch, A. C.; Michael, M.; Ngan, Samuel Y; Phillips, Wayne A.; Ramsay, George; Heriot, Alexander G.

doi:10.1111/codi.14106

Cited by 53 publications

(49 citation statements)

References 59 publications

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“…However, even though nCRT results in clinically significant tumor regression for most patients, a considerable portion of patients exhibit very poor or no response to treatment. The rate of non-responders in current literature is about 20-30% [14,32]. However, 53% of the patients in the current study had poor to no response to nCRT.…”

Section: Discussionmentioning

confidence: 48%

“…However, with routine clinical use of preoperative CRT, it was evident that tumor response to this treatment ranges from complete to absent response [8,15,26]. This led to the development of various scales designed to quantify the level of response to neoadjuvant therapy [14]. Many studies have shown that response to nCRT correlates with prognosis and specifically DFS [11][12][13].…”

Section: Discussionmentioning

confidence: 99%

“…The higher nonresponse rate is probably related to the use of different tumor regression scales. All previous studies shared the same remarkable limitation, which was the absence of a uniform method to rat tumor response [14,23]. Several systems to quantify tumor response have been advocated, complicating implementation of a universal, standard definition for tumor regression.…”

Section: Discussionmentioning

confidence: 99%

“…TRS 0 indicates pathological complete response (pCR), TRS 1-2 indicates different grades of partial response and TRS 3 indicates poor or no response. Correlation between the level of tumor regression and oncological outcome is quite evident [11][12][13][14]. PCR is evident in up to 20% of patients and was shown to be associated with long-term oncologic benefits, including excellent DFS and OS rates [17][18][19].…”

Section: Introductionmentioning

confidence: 99%

“…Studies focusing on the non-responders' group (TRS 3) are less common. Many studies grouped partial responders and nonresponders together comparing them to complete responders while recent data suggest that partial responders are more similar to complete responders than they are to non-responders in terms of long-term outcomes [14,[23][24][25]. The aim of this study was to evaluate the prevalence and impact of poor pathological response (TRS 3) based on the recently adopted TRS grading system by the college of the American pathologists on long-term oncologic outcomes (DFS and cancer specific survival (CSS) among rectal cancer patients treated with neoadjuvant CRT before surgical resection [9].…”

Section: Introductionmentioning

confidence: 99%

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Lack of Pathological Response of Rectal Cancer to Neoadjuvant Chemoradiotherapy is Associated with Poorer Long-Term Oncological Outcomes

Kidron¹,

Lahav²,

Berkovich³

et al. 2019

COR

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Keywords:Tumor regression score neoadjuvant response rectal cancer A B S T R A C TPurpose: Tumor regression scores are used to evaluate local response to preoperative treatment. Complete pathological response (tumor regression score=0) is associated with excellent prognosis. In this study we evaluated the prevalence and impact of poor-to-no pathological response to neoadjuvant treatment (tumor regression score=3), based on a recently revised grading system on long term oncologic outcomes among rectal cancer patients. Methods: This retrospective study included rectal cancer patients who received . neoadjuvant chemoradiotherapy and surgical resection at our medical center. Pathological specimens were ren evaluated and graded (grades 0-3) based on the revised tumor regression scores. Disease free survival and cancer specific survival rates were documented and matched with the patients' tumor regression scores. Results: Initially 78 patients were included. 6 patients were later excluded from the long-term follow up since they developed disease progression during neoadjuvant treatment. Among the other 72 patients, 38 (52.8%) were classified as tumor regression score=3 (no response) and 34 (47.2%) tumor regression score=0-2 (any level of response). Conversion from laparoscopy to open surgery was higher in the tumor regression score=3 group (21% vs. 2.9%, p=0.02). Follow-up ranged from 5 months to 12 years. Nine (12.5%) patients experienced disease recurrence, 8 with tumor regression score=3. Most recurrences were metastases to liver and lungs. Disease free survival was lower in tumor regression score=3 patients as compared to tumor regression score=0-2.Conclusions: Non-responders to neoadjuvant therapy are at higher risk for disease recurrence, conversion to open surgery and disease-related mortality. Systemic recurrence of tumor regression score=3 tumors suggests an aggressive biology of these tumors. Further studies are needed to characterize tumors that are less likely to respond to radiotherapy and to personalize preoperative treatment decisions .

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Section: Discussionmentioning

confidence: 48%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Lack of Pathological Response of Rectal Cancer to Neoadjuvant Chemoradiotherapy is Associated with Poorer Long-Term Oncological Outcomes

Kidron¹,

Lahav²,

Berkovich³

et al. 2019

COR

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Impact of single‐nucleotide polymorphisms in DNA repair pathway genes on response to chemoradiotherapy in rectal cancer patients: Results from ACCORD‐12/PRODIGE‐2 phase III trial

Boige

Mollévi

Gourgou

et al. 2019

Intl Journal of Cancer

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We examined whether 66 germline single-nucleotide polymorphisms (SNPs) in 10 candidate genes would predict clinical outcome in 316 patients with resectable locally advanced rectal cancer (LARC) enrolled in the ACCORD-12 phase III trial who were randomly treated with preoperative radiotherapy plus capecitabine (CAP45; n = 155) or dose-intensified radiotherapy plus capecitabine and oxaliplatin (CAPOX50; n = 161). The primary endpoint was tumor response according to the Dworak score. Multivariate logistic regression models adjusted on treatment arm and T stage determined the SNPs prognostic and predictive values for tumor response. In univariate analysis, five SNPs in ERCC2, XPA, MTHFR and ERCC1 were associated with the Dworak score in the CAPOX50 arm. In the overall population, interaction with treatment arm was significant for ERCC2 rs1799787 (p interaction = 0.05) and XPA rs3176683 (p interaction = 0.008), suggesting a predictive effect for response to oxaliplatin-based chemoradiotherapy (CRT). All but XPA rs3176683 had a prognostic effect on tumor response. In a multivariate model, interaction remained significant for XPA rs3176683 ([OR 7.33, 95% CI 1.40-38.23], p interaction = 0.018) and the prognostic effect significant for ERCC2 rs1799787 ([OR 0.55, 95%CI 0.32-0.93], p = 0.027) and ERCC1 rs10412761 ([OR 0.57, 95%CI 0.34-0.98], p = 0.042). Patients with the T/G haplotype of rs1799787 and rs10412761 had a 60% decrease in odds of response (p < 0.001). None of the five SNPs were associated with toxicity, overall and disease-free survival. These data suggest that genetic variation in DNA repair genes influences response to preoperative CRT in LARC and identify patients who benefit from the addition of oxaliplatin to CRT.

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Advanced Radiologic Imaging Techniques of the Gastrointestinal Tract

Voyvodic

Jenkins

Knox

2019

Gastroenterology for General Surgeons

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Prognostic value of tumour regression grade in locally advanced rectal cancer: a systematic review and meta‐analysis

Abstract: In conclusion, the degree of TRG was of prognostic value in predicting long-term outcomes. The current challenge is the development of a high-validity tests to predict pCR.

Cited by 53 publications

References 59 publications

Lack of Pathological Response of Rectal Cancer to Neoadjuvant Chemoradiotherapy is Associated with Poorer Long-Term Oncological Outcomes

Lack of Pathological Response of Rectal Cancer to Neoadjuvant Chemoradiotherapy is Associated with Poorer Long-Term Oncological Outcomes

Impact of single‐nucleotide polymorphisms in DNA repair pathway genes on response to chemoradiotherapy in rectal cancer patients: Results from ACCORD‐12/PRODIGE‐2 phase III trial

Advanced Radiologic Imaging Techniques of the Gastrointestinal Tract

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