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Comparison of Five Pathological Tumor Regression Grading Systems for Rectal Cancer Following Chemoradiation:

Sahaphol Anannamcharoen¹, Chinakrit Boonya-Ussadorn¹, K Satayasoontorn²

¹Department of Surgery, Phramongkutklao Hospital, Thailand.

Asian Pacific Journal of Cancer Prevention : APJCP

|January 28, 2025

Summary

This summary is machine-generated.

Tumor regression grading (TRG) systems assessing fibrosis and residual tumor show strong correlations. The modified Ryan TRG system, focusing only on residual cancer cells, demonstrated lower reliability in this rectal adenocarcinoma study.

Keywords:

Correlation coefficient Test-Retest chemoradiotherapy rectal cancer tumor regression grade

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Area of Science:

Oncology
Pathology
Medical Imaging

Background:

Accurate tumor regression grading (TRG) is crucial for evaluating neoadjuvant therapy response in rectal adenocarcinoma.
Standardized TRG systems are essential for consistent clinical interpretation and research.

Purpose of the Study:

To evaluate the correlation among five distinct tumor regression grading systems.
To assess the test-retest reliability and internal validity of these TRG systems in rectal cancer specimens.

Main Methods:

A test-retest reliability study was conducted on 34 rectal adenocarcinoma specimens post-neoadjuvant chemoradiotherapy (CRT).
Pathologists assessed each specimen twice, 3 weeks apart, using five TRG systems: Dworak, Mandard, Ryan, AJCC, and modified Ryan.
Intra-rater reliability was analyzed to determine consistency.

Main Results:

TRG systems evaluating both residual tumor and therapy-induced fibrosis demonstrated very strong correlations (0.964–1.0).
The modified Ryan system, based solely on residual viable cancer cells, showed lower correlations (0.549–0.617).
Excellent intra-rater correlation coefficients were observed for Mandard (0.947), Dworak (0.947), Ryan (0.918), AJCC (0.957), and modified Ryan (0.934) systems.

Conclusions:

TRG systems incorporating both residual tumor and fibrosis exhibit high inter-system correlation.
The modified Ryan TRG system may lead to interpretation discrepancies due to its sole reliance on residual cancer cell quantity.
The study confirms excellent intra-rater reliability for most TRG systems, indicating high internal validity.