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Clinical Impact of Tumor Regression Grade after Preoperative Chemoradiation for Locally Advanced Rectal Cancer: Subset Analyses in Lymph Node Negative Patients

대한대장항문학회지 2011년 27권 1호 p.31 ~ 40
 ( Min Byung-Soh ) - Yonsei University College of Medicine Department of Surgery

 ( Kim Nam-Kyu ) - Yonsei University College of Medicine Department of Surgery
 ( Pyo Ju-Yeon ) - Yonsei University College of Medicine Department of Pathology
 ( Kim Ho-Guen ) - Yonsei University College of Medicine Department of Pathology
 ( Seong Jin-Sil ) - Yonsei University College of Medicine Department of Radiation Oncology
금기창 ( Keum Ki-Chang ) - Yonsei University College of Medicine Department of Radiation Oncology
 ( Sohn Seung-Kook ) - Yonsei University College of Medicine Department of Surgery
 ( Cho Chang-Hwan ) - Yonsei University College of Medicine Department of Surgery

Abstract


Background: We investigated the prognostic significance of tumor regression grade (TRG) after preoperative chemoradiation therapy (preop-CRT) for locally advanced rectal cancer especially in the patients without lymph node metastasis.

Methods: One-hundred seventy-eight patients who had cT3/4 tumors were given 5,040 cGy preoperative radiation with 5-fluorouracil/leucovorin chemotherapy. A total mesorectal excision was performed 4-6 weeks after preop-CRT. TRG was defined as follows: grade 1 as no cancer cells remaining; grade 2 as cancer cells outgrown by fibrosis; grade 3 as a minimal presence or absence of regression. The prognostic significance of TRG in comparison with histopathologic staging was analyzed.

Results: Seventeen patients (9.6%) showed TRG1. TRG was found to be significantly associated with cancer-specific survival (CSS; P = 0.001) and local recurrence (P = 0.039) in the univariate study, but not in the multivariate analysis. The ypN stage was the strongest prognostic factor in the multivariate analysis. Subgroup analysis revealed TRG to be an independent prognostic factor for the CSS of ypN0 patients (P = 0.031). TRG had a stronger impact on the CSS of ypN (-) patients (P = 0.002) than on that of ypN (+) patients (P = 0.521). In ypT2N0 and ypT3N0, CSS was better for TRG2 than for TRG3 (P = 0.041, P = 0.048), and in ypN (-) and TRG2 tumors, CSS was better for ypT1-2 than for ypT3-4 (P = 0.034).

Conclusion: TRG was found to be the strongest prognostic factor in patients without lymph node metastasis (ypN0), and different survival was observed according to TRG among patients with a specific histopathologic stage. Thus, TRG may provide an accurate prediction of prognosis and may be used for f tailoring treatment for patients without lymph node metastasis.

키워드

Tumor regression grade; Preoperative chemoradiation; Tumor response; Rectal cancer; Histopathologic stage; Prognosis
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