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Rectal tumor fragmentation as a response pattern following chemoradiation.
Matthew N Mills1, Afrin Naz2, Julian Sanchez3
1Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
Journal of Gastrointestinal Oncology
|January 13, 2023
Summary
Minimal tumor response in rectal adenocarcinoma, indicated by AJCC TRG score 3, predicts poor disease-free survival irrespective of ypTN stage. This highlights TRG as a crucial prognostic factor for treatment response in locally advanced rectal cancer.
Area of Science:
- Oncology
- Surgical Pathology
- Clinical Research
Background:
- Tumor response to neoadjuvant therapy in locally advanced rectal adenocarcinoma (LARC) is heterogeneous and prognostically significant.
- Tumor regression grading (TRG) and ypTN staging are common response classification methods but can be discordant.
- Comparing the prognostic value of these discordant measures is crucial for patient risk stratification.
Purpose of the Study:
- To compare the prognostic value of tumor response measurements categorized by the AJCC/CAP TRG schema and ypTN stage.
- To determine which classification method better predicts disease-free survival in LARC patients.
- To identify patterns of residual disease associated with poor treatment outcomes.
Main Methods:
- Retrospective review of 90 LARC patients treated with neoadjuvant chemoradiation, TME, and adjuvant chemotherapy.
- Consensus AJCC TRG assignment by two pathologists.
- Cox proportional hazards ratio model to assess factors influencing disease-free survival (DFS).
Main Results:
- ypTN downstaging was not prognostically significant in multivariate analysis.
- AJCC TRG score 3 (minimal tumor response) strongly predicted inferior DFS (3-year DFS 79% vs. 25%, P<0.001).
- Patients with TRG 3 had significantly higher risks of local and distant failure.
Conclusions:
- Minimal tumor response (AJCC TRG 3) is a high-risk pattern for recurrence, regardless of ypTN downstaging.
- TRG may better reflect residual disease patterns than ypTN staging.
- Further study is needed to optimize tumor response categorization for patient risk stratification and management.
