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Rectal cancer staging post neoadjuvant therapy--how should the changes be assessed?
Adrian C Bateman1, Eleanor Jaynes, Andrew R Bateman
1Department of Cellular Pathology, Southampton General Hospital, University of Southampton, Southampton, UK. adrian.bateman@suht.swest.nhs.uk
Histopathology
|May 15, 2009
Summary
Three rectal cancer histopathology scoring systems showed good agreement for assessing tumour regression after neoadjuvant chemoradiotherapy. The modified Rectal Cancer Regression Grade (m-RCRG) system best balances applicability and accurate recording of regression degrees.
Area of Science:
- Oncology
- Pathology
- Gastroenterology
Background:
- Neoadjuvant chemoradiotherapy is standard for rectal cancer.
- Histopathological assessment of tumour regression is crucial for predicting outcomes.
- Standardized scoring systems are needed for reproducible evaluation.
Purpose of the Study:
- To compare the utility and reproducibility of three tumour regression grade (TRG) scoring systems.
- To evaluate the Tumour Regression Grade (TRG), modified Rectal Cancer Regression Grade (m-RCRG), and RCPath Cancer Dataset (RCPath) methods.
- To determine the optimal system for clinical and research applications.
Main Methods:
- Retrospective analysis of 54 rectal cancer resection specimens.
- Independent assessment of histopathological features using TRG, m-RCRG, and RCPath systems.
- Calculation of interobserver agreement using kappa scores.
Main Results:
- All three scoring systems demonstrated good interobserver agreement (kappa scores ranging from 0.719 to 0.742).
- Complete tumour regression was identified in 20% of cases, and little/no regression in 11% of cases.
- A mean of 5.6 tumour blocks and 8.4 lymph nodes were examined per case.
Conclusions:
- All evaluated TRG scoring systems are usable in a diagnostic setting.
- The m-RCRG system offers the best balance of applicability and accurate recording of regression.
- The m-RCRG system is recommended for future clinicopathological studies on tumour regression and clinical outcome.
