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Clinical Significance of Tumor Regression Grade in Rectal Cancer with Preoperative Chemoradiotherapy

대한대장항문학회지 2010년 26권 4호 p.279 ~ 286
 ( Park Young-Joo ) - 전남대학교 의과대학 외과학교실

오병렬 ( Oh Byung-Ryul ) - 전남대학교 의과대학 외과학교실
임상우 ( Lim Sang-Woo ) - 전남대학교 의과대학 외과학교실
허정욱 ( Huh Jung-Wook ) - 전남대학교 의과대학 외과학교실
 ( Joo Jae-Kyun ) - 전남대학교 의과대학 외과학교실
김영진 ( Kim Young-Jin ) - 전남대학교 의과대학 외과학교실
김형록 ( kim Hyeong-Rok ) - 전남대학교 의과대학 외과학교실

Abstract


Purpose: Neoadjuvant chemoradiotherapy applied to the locally advanced rectal cancer reduces local recurrence and improves survival. We assessed tumor regression grade (TRG) and its influence on survival in rectal cancer patients treated with chemoradiotherapy followed by surgical resection.

Methods: We studied 108 patients that were seen at our hospital between August 2004 and December 2008. Patients received preoperative chemoradiotherapy consisting of 5-fluorouracil and leucovorin by continous infusion during the first and fifth week, delivered with concurrent pelvic radiation of 50.4 Gy, followed by radical surgery at 6-8 weeks. The TRG was determined by the amount of fibrosis in the tumor embedding area and was divided into 5 grades based on the relative amount of fibrosis. We analyzed all preoperative clinicopathologic factors, postoperative pathologic stages, TRG and prognosis, retrospectively.

Results: Downstaging of rectal cancer through neoadjuvant chemoradiotherapy occurred in 64 (59%) patients. The numbers of total regressions (TRG4), good regressions (TRG3), moderate regressions (TRG2), minor regressions (TRG1), and no regression (TRG0) were 19 (18%), 65 (60%), 17 (16%), 6 (5%), and 1 (1%) respectively. The TRG was inversely correlated with perineural invasion and lymphovascular invasion (P = 0.008, P = 0.032). The local recurrence rate declined as the tumor regression grade increased (P = 0.032). The 19 patients with TRG4 had a better three-year disease free survival than the 89 patients with TRG0-3 (P = 0.034). The 16 patients with pathologic complete remission (pCR) had a better three-year disease free survival than the 92 patients with non-pCR (P = 0.025).

Conclusion: Higher TRG after preoperative chemoradiotherapy for rectal cancer closely correlates with better survival and low local recurrence. The TRG is considered to be a significant prognostic factor.

키워드

Rectal cancer; Tumor regression grade; Preoperative chemoradiotherapy
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