TY - JOUR
T1 - College of American Pathologists Tumor Regression Grading System for Long-Term Outcome in Patients with Locally Advanced Rectal Cancer
AU - Chen, Hai Yang
AU - Feng, Li Li
AU - Li, Ming
AU - Ju, Huai Qiang
AU - Ding, Yi
AU - Lan, Mei
AU - Song, Shu Mei
AU - Han, Wei Dong
AU - Yu, Li
AU - Wei, Ming Biao
AU - Pang, Xiao Lin
AU - He, Fang
AU - Liu, Shuai
AU - Zheng, Jian
AU - Ma, Yan
AU - Lin, Chu Yang
AU - Lan, Ping
AU - Huang, Mei Jin
AU - Zou, Yi Feng
AU - Yang, Zu Li
AU - Wang, Ting
AU - Lang, Jin Yi
AU - Orangio, Guy R.
AU - Poylin, Vitaliy
AU - Ajani, Jaffer A.
AU - Wang, Wei Hu
AU - Wan, Xiang Bo
N1 - Funding Information:
This work is supported by National Natural Science Foundation of China (81872188); National Natural Science Foundation for Young Scholars of China (81703080); International Center for Genetic Engineering and Biotechnology grant (CRP/CHN16–04_EC).
Funding Information:
With deepest grief and highest reverence, the authors gratefully thank the support of Dr. Lei Wang, ex-dean of the Sixth Affiliated Hospital of Sun Yat-sen University, who devoted his whole life to colorectal cancer and radiation enteritis field. His noteworthy dedication to the cause as well as his extraordinary benevolence, dauntlessness, and selflessness will be forever remembered and honored. Dear Dr. Wang, we miss you. This work is supported by National Natural Science Foundation of China (81872188); National Natural Science Foundation for Young Scholars of China (81703080); International Center for Genetic Engineering and Biotechnology grant (CRP/CHN16?04_EC).
Publisher Copyright:
© 2021 AlphaMed Press
PY - 2021/5
Y1 - 2021/5
N2 - Background: The National Comprehensive Cancer Network's Rectal Cancer Guideline Panel recommends American Joint Committee of Cancer and College of American Pathologists (AJCC/CAP) tumor regression grading (TRG) system to evaluate pathologic response to neoadjuvant chemoradiotherapy for locally advanced rectal cancer (LARC). Yet, the clinical significance of the AJCC/CAP TRG system has not been fully defined. Materials and Methods: This was a multicenter, retrospectively recruited, and prospectively maintained cohort study. Patients with LARC from one institution formed the discovery set, and cases from external independent institutions formed a validation set to verify the findings from discovery set. Overall survival (OS), disease-free survival (DFS), local recurrence-free survival (LRFS), and distant metastasis-free survival (DMFS) were assessed by Kaplan-Meier analysis, log-rank test, and Cox regression model. Results: The discovery set (940 cases) found, and the validation set (2,156 cases) further confirmed, that inferior AJCC/CAP TRG categories were closely /ccorrelated with unfavorable survival (OS, DFS, LRFS, and DMFS) and higher risk of disease progression (death, accumulative relapse, local recurrence, and distant metastasis) (all p <.05). Significantly, pairwise comparison revealed that any two of four TRG categories had the distinguished survival and risk of disease progression. After propensity score matching, AJCC/CAP TRG0 category (pathological complete response) patients treated with or without adjuvant chemotherapy displayed similar survival of OS, DFS, LRFS, and DMFS (all p >.05). For AJCC/CAP TRG1–3 cases, adjuvant chemotherapy treatment significantly improved 3-year OS (90.2% vs. 84.6%, p <.001). Multivariate analysis demonstrated the AJCC/CAP TRG system was an independent prognostic surrogate. Conclusion: AJCC/CAP TRG system, an accurate prognostic surrogate, appears ideal for further strategizing adjuvant chemotherapy for LARC. Implications for Practice: The National Comprehensive Cancer Network recommends the American Joint Committee of Cancer and College of American Pathologists (AJCC/CAP) tumor regression grading (TRG) four-category system to evaluate the pathologic response to neoadjuvant treatment for patients with locally advanced rectal cancer; however, the clinical significance of the AJCC/CAP TRG system has not yet been clearly addressed. This study found, for the first time, that any two of four AJCC/CAP TRG categories had the distinguished long-term survival outcome. Importantly, adjuvant chemotherapy may improve the 3-year overall survival for AJCC/CAP TRG1–3 category patients but not for AJCC/CAP TRG0 category patients. Thus, AJCC/CAP TRG system, an accurate surrogate of long-term survival outcome, is useful in guiding adjuvant chemotherapy management for rectal cancer.
AB - Background: The National Comprehensive Cancer Network's Rectal Cancer Guideline Panel recommends American Joint Committee of Cancer and College of American Pathologists (AJCC/CAP) tumor regression grading (TRG) system to evaluate pathologic response to neoadjuvant chemoradiotherapy for locally advanced rectal cancer (LARC). Yet, the clinical significance of the AJCC/CAP TRG system has not been fully defined. Materials and Methods: This was a multicenter, retrospectively recruited, and prospectively maintained cohort study. Patients with LARC from one institution formed the discovery set, and cases from external independent institutions formed a validation set to verify the findings from discovery set. Overall survival (OS), disease-free survival (DFS), local recurrence-free survival (LRFS), and distant metastasis-free survival (DMFS) were assessed by Kaplan-Meier analysis, log-rank test, and Cox regression model. Results: The discovery set (940 cases) found, and the validation set (2,156 cases) further confirmed, that inferior AJCC/CAP TRG categories were closely /ccorrelated with unfavorable survival (OS, DFS, LRFS, and DMFS) and higher risk of disease progression (death, accumulative relapse, local recurrence, and distant metastasis) (all p <.05). Significantly, pairwise comparison revealed that any two of four TRG categories had the distinguished survival and risk of disease progression. After propensity score matching, AJCC/CAP TRG0 category (pathological complete response) patients treated with or without adjuvant chemotherapy displayed similar survival of OS, DFS, LRFS, and DMFS (all p >.05). For AJCC/CAP TRG1–3 cases, adjuvant chemotherapy treatment significantly improved 3-year OS (90.2% vs. 84.6%, p <.001). Multivariate analysis demonstrated the AJCC/CAP TRG system was an independent prognostic surrogate. Conclusion: AJCC/CAP TRG system, an accurate prognostic surrogate, appears ideal for further strategizing adjuvant chemotherapy for LARC. Implications for Practice: The National Comprehensive Cancer Network recommends the American Joint Committee of Cancer and College of American Pathologists (AJCC/CAP) tumor regression grading (TRG) four-category system to evaluate the pathologic response to neoadjuvant treatment for patients with locally advanced rectal cancer; however, the clinical significance of the AJCC/CAP TRG system has not yet been clearly addressed. This study found, for the first time, that any two of four AJCC/CAP TRG categories had the distinguished long-term survival outcome. Importantly, adjuvant chemotherapy may improve the 3-year overall survival for AJCC/CAP TRG1–3 category patients but not for AJCC/CAP TRG0 category patients. Thus, AJCC/CAP TRG system, an accurate surrogate of long-term survival outcome, is useful in guiding adjuvant chemotherapy management for rectal cancer.
KW - Adjuvant chemotherapy
KW - Locally advanced rectal cancer
KW - Neoadjuvant treatments
KW - Survival outcome
KW - Tumor regression grade system
UR - http://www.scopus.com/inward/record.url?scp=85101248687&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85101248687&partnerID=8YFLogxK
U2 - 10.1002/onco.13707
DO - 10.1002/onco.13707
M3 - Article
C2 - 33543577
AN - SCOPUS:85101248687
SN - 1083-7159
VL - 26
SP - e780-e793
JO - Oncologist
JF - Oncologist
IS - 5
ER -
