The prognostic value of tumour regression grade following neoadjuvant chemoradiation therapy for rectal cancer

Abdul-Jalil, Khairun I.; Sheehan, Katherine M.; Kehoe, Joan; Cummins, Robert; O’Grady, Anthony; McNamara, Deborah A.; Deasy, Joseph; Breathnach, Oscar S.; Grogan, Liam; O’Neill, Brian; Faul, C.; Parker, Imelda; Kay, Elaine W.; Hennessy, Bryan T.; Gillen, Peter

doi:10.1111/codi.12439

Cited by 43 publications

(41 citation statements)

References 17 publications

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“…In these data sets, the use of ACEIs/ARBs did not significantly affect LR‐free survival, metastasis‐free survival, or OS. Prior studies have consistently identified a positive association between pCR and improved rates of locoregional disease control and OS . However, in these databases from UW and UH, the association of pCR with LR and OS rates did not reach significance.…”

Section: Discussionmentioning

confidence: 68%

Increased tumor response to neoadjuvant therapy among rectal cancer patients taking angiotensin‐converting enzyme inhibitors or angiotensin receptor blockers

Morris

Saha

Magnuson

et al. 2016

Cancer

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BACKGROUND: Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are commonly used antihypertensive medications that have been reported to affect aberrant angiogenesis and the dysregulated inflammatory response. Because of such mechanisms, it was hypothesized that these medications might affect the tumor response to neoadjuvant radiation in patients with rectal cancer. METHODS: One hundred fifteen patients who were treated with neoadjuvant radiation at the University of Wisconsin (UW) between 1999 and 2012 were identified. Univariate analyses were performed with anonymized patient data. In a second independent data set, 186 patients with rectal cancer who were treated with neoadjuvant radiation at the Queen's Medical Center of the University of Hawaii (UH) between 1995 and 2010 were identified. These data were independently analyzed as before. Multivariate analyses were performed with aggregate data. RESULTS: Among patients taking ACEIs/ARBs in the UW data set, a significant 3-fold increase in the rate of pathologic complete response (pCR) to neoadjuvant therapy (52% vs 17%, P 5 .001) was observed. This finding was confirmed in the UH data set, in which a significant 2-fold-increased pCR rate (24% vs 12%, P 5 .03) was observed. Identified patient and treatment characteristics were otherwise balanced between patients taking and not taking ACEIs/ ARBs. No significant effect was observed on pCR rates with other medications, including statins, metformin, and aspirin. Multivariate analyses of aggregate data identified ACEI/ARB use as a strong predictor of pCR (odds ratio, 4.02; 95% confidence interval, 2.06-7.82; P < .001). CONCLUSIONS: The incidental use of ACEIs/ARBs among patients with rectal cancer is associated with a significantly increased rate of pCR after neoadjuvant treatment. Cancer 2016;122:2487-95.

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Section: Discussionmentioning

confidence: 68%

Increased tumor response to neoadjuvant therapy among rectal cancer patients taking angiotensin‐converting enzyme inhibitors or angiotensin receptor blockers

Morris

Saha

Magnuson

et al. 2016

Cancer

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“…Prognostic markers such as ypN, LVI and PNI are commonly used to assess patient's risk of recurrence and therefore negate recommendation for adjuvant chemotherapy. However inconsistent reports on the significance of these markers to predict patient's prognosis is a concern . By comparing the pooled HR results for each covariate, no response has the highest HR of 2.97, compared with the LVI HR of 1.4, the ypN HR of 2.2 and the PNI HR of 2.3.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2018

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“…The American Joint Committee on Cancer/College of American Pathologists (AJCC/CAP) recommended in 2010 to use a three tiered-system that considers the relative proportion of fibrosis and viable tumor cells, as proposed by Ryan et al (4,5). Many authors have analyzed the prognostic significance of the different pathologic response grading systems with varying results (6,7), but very few studies have compared the different response patterns found in the tumor. The aim of this study is to analyze the pathologic response in our series of 183 patients from two Spanish hospitals and to determine whether there are different patterns of response and their prognostic significance.…”

Section: Original Articlementioning

confidence: 99%

Prognostic influence of histopathological regression patterns in rectal adenocarcinoma receiving neoadjuvant therapy

Fernández-Aceñero¹,

Muñoz²,

Varela³

et al. 2017

J. Gastrointest. Oncol.

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Results: A total of 183 patients from two hospitals. The concordance rate between pathologists was good. In total, 18% of the patients showed grade 0 (complete response), 31.7% grade 1, 19.2% grade 2 and 31.1% grade 3 regression. T down-staging was found in 51.9% of the cases. 46 patients recurred and 18 died of disease (median follow-up time: 39 months). We found a statistically significant association between pathological response and pT stage and down-staging. Inflammatory reaction in the tumor bed was significantly associated to regression and prognosis. Cox's multivariate analysis of survival revealed that down-staging and presence of mucin pools in the tumor bed behaved as significant predictors of recurrence and regression grade and mucin pools as significant predictors of survival.Conclusions: Pathological response is an important surrogate marker of prognosis in some large series, but results are varying. There are many systems to grade regression and this makes it difficult to compare the results by different groups. It is important to report the specific pattern of response, for some of them may have prognostic relevance. We feel there is an urgent need to develop standarized protocols and employ a universal regression scheme if we intend to use this factor to guide therapy.

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The prognostic value of tumour regression grade following neoadjuvant chemoradiation therapy for rectal cancer

Abstract: Our findings support the notion that ypCR status, nodal status after neoadjuvant CRT and CRM status, but not TRG, are predictors of long-term survival in patients with locally advanced rectal cancer.

Cited by 43 publications

References 17 publications

Increased tumor response to neoadjuvant therapy among rectal cancer patients taking angiotensin‐converting enzyme inhibitors or angiotensin receptor blockers

Increased tumor response to neoadjuvant therapy among rectal cancer patients taking angiotensin‐converting enzyme inhibitors or angiotensin receptor blockers

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

Prognostic influence of histopathological regression patterns in rectal adenocarcinoma receiving neoadjuvant therapy

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