Criteria of tumor regression grade and its application in diagnosis and treatment of rectal cancer

doi:10.3877/cma.j.issn.2095-3224.2016.06.001

Abstract

Abstract:

Along with the neoajuvant treatment popularized in rectal cancer treatment, tumor regression grade (TRG) has gradually attracted broad attention. Several studies have validated that TRG correlated well with neoajuvant treatment response and prognosis of patients, thus TRG has broad application prospect in prognosis prediction, follow-up and clinical decision, some other researches began to consider it as a surrogate endpoint in clinical trials. However, different systems of TRG couldn′t be unified and standardized. This review was to make a comparison of several popular systems of TRG and explore the clinical application of TRG in rectal cancer treatment.

Key words: Rectal neoplasms, Prognosis, Tumor regression grade, Clinical trial

Yinuo Tan, Haiyan Chen, Kefeng Ding. Criteria of tumor regression grade and its application in diagnosis and treatment of rectal cancer[J]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2016, 05(06): 458-462.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhjzcjbdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-3224.2016.06.001

https://zhjzcjbdzzz.cma-cmc.com.cn/EN/Y2016/V05/I06/458

Figures/Tables 1

References 26

[1]	Becker K,Mueller JD,Schulmacher C, et al. Histomorphology and grading of regression in gastric carcinoma treated with neoadjuvant chemotherapy[J]. Cancer, 2003, 98(7): 1521-1530.
[2]	Dworak O,Keilholz L and Hoffmann A. Pathological features of rectal cancer after preoperative radiochemotherapy[J]. Int J Colorectal Dis, 1997, 12(1): 19-23.
[3]	Mandard AM,Dalibard F,Mandard JC, et al. Pathologic assessment of tumor regression after preoperative chemoradiotherapy of esophageal carcinoma. Clinicopathologic correlations[J]. Cancer, 1994, 73(11): 2680-2686.
[4]	Rodel C,Martus P,Papadoupolos T, et al. Prognostic significance of tumor regression after preoperative chemoradiotherapy for rectal cancer[J]. Journal of clinical oncology: official journal of the American Society of Clinical Oncology, 2005, 23(34): 8688-8696.
[5]	Wheeler JM,Warren BF,Mortensen NJ, et al. Quantification of histologic regression of rectal cancer after irradiation: a proposal for a modified staging system[J]. Diseases of the colon and rectum, 2002, 45(8): 1051-1056.
[6]	Quah HM,Chou JF,Gonen M, et al. Pathologic stage is most prognostic of disease-free survival in locally advanced rectal cancer patients after preoperative chemoradiation[J]. Cancer, 2008, 113(1): 57-64.
[7]	Zhang LN,Xiao WW,Xi SY, et al. Pathological Assessment of the AJCC Tumor Regression Grading System After Preoperative Chemoradiotherapy for Chinese Locally Advanced Rectal Cancer[J]. Medicine, 2016, 95(3): e2272.
[8]	Wheeler JM,Dodds E,Warren BF, et al. Preoperative chemoradiotherapy and total mesorectal excision surgery for locally advanced rectal cancer: correlation with rectal cancer regression grade[J]. Diseases of the colon and rectum, 2004, 47(12): 2025-2031.
[9]	Pucciarelli S,Toppan P,Friso ML, et al. Complete pathologic response following preoperative chemoradiation therapy for middle to lower rectal cancer is not a prognostic factor for a better outcome[J]. Diseases of the colon and rectum, 2004, 47(11): 1798-1807.
[10]	Maas M,Nelemans PJ,Valentini V, et al. Long-term outcome in patients with a pathological complete response after chemoradiation for rectal cancer: a pooled analysis of individual patient data[J]. The Lancet Oncology, 2010, 11(9): 835-844.
[11]	Patel UB,Taylor F,Blomqvist L, et al. Magnetic resonance imaging-detected tumor response for locally advanced rectal cancer predicts survival outcomes: MERCURY experience[J]. Journal of clinical oncology: official journal of the American Society of Clinical Oncology, 2011, 29(28): 3753-3760.
[12]	Pucciarelli S,De Paoli A,Guerrieri M, et al. Local excision after preoperative chemoradiotherapy for rectal cancer: results of a multicenter phase II clinical trial[J]. Diseases of the colon and rectum, 2013, 56(12): 1349-1356.
[13]	Habr-Gama A,Sabbaga J,Gama-Rodrigues J, et al. Watch and wait approach following extended neoadjuvant chemoradiation for distal rectal cancer: are we getting closer to anal cancer management?[J]. Diseases of the colon and rectum, 2013, 56(10): 1109-1117.
[14]	Maas M,Beets-Tan RG,Lambregts DM, et al. Wait-and-see policy for clinical complete responders after chemoradiation for rectal cancer[J]. Journal of clinical oncology: official journal of the American Society of Clinical Oncology, 2011, 29(35): 4633-4640.
[15]	Bosset JF,Collette L,Calais G, et al. Chemotherapy with preoperative radiotherapy in rectal cancer[J]. The New England journal of medicine, 2006, 355(11): 1114-1123.
[16]	Kockerling F,Raymond MA,Altendorf-Hofmann A, et al. Influence of surgery on metachronous distant metastases and survival in rectal cancer[J]. Journal Of Clinical Oncology, 1998, 16(1): 324-329.
[17]	Glynne-Jones R,Mawdsley S,Pearce T, et al. Alternative clinical end points in rectal cancer--are we getting closer?[J]. Annals of oncology: official journal of the European Society for Medical Oncology / ESMO, 2006, 17(8): 1239-1248.
[18]	De Gruttola VG,Clax P,DeMets DL, et al. Considerations in the evaluation of surrogate endpoints in clinical trials: Summary of a National Institutes of Health Workshop[J]. Controlled Clinical Trials, 2001, 22(5): 485-502.
[19]	Buyse M and Molenberghs G. Criteria for the validation of surrogate endpoints in randomized experiments[J]. Biometrics, 1998, 54(3): 1014-1029.
[20]	Bosset JF,Calais G,Mineur L, et al. Preoperative radiation (Preop RT) in rectal cancer: Effect and timing of additional chemotherapy (CT) 5-year results of the EORTC 22921 trial[J]. Journal Of Clinical Oncology, 2005, 23(16): 247S-247S.
[21]	Conroy T,Bonnetain F,Chapet O, et al. Preoperative (preop) radiotherapy (RT)+5FU/folinic acid (FA) in T3, 4 rectal cancers: Preliminary results of the FFCD 9203 randomized trial[J]. Journal Of Clinical Oncology, 2004, 22(14): 276S-276S.
[22]	Sauer R,Becker H,Hohenberger W, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer[J]. New England Journal Of Medicine, 2004, 351(17): 1731-1740.
[23]	Gerard J,Bonnetain F,Conroy T, et al. Preoperative concurrent chemoradiotherapy (CT-RT) improves local control in T3-4 rectal cancers. Results of the FFCD 9203 randomized trial[J]. Ejc Supplements, 2005, 3(2): 170.
[24]	Bosset J-F,Collette L,Calais G, et al. Chemotherapy with preoperative radiotherapy in rectal cancer[J]. New England Journal Of Medicine, 2006, 355(11): 1114-1123.
[25]	Sargent DJ,Patiyil S,Yothers G, et al. End points for colon cancer adjuvant trials: observations and recommendations based on individual patient data from 20, 898 patients enrolled onto 18 randomized trials from the ACCENT Group[J]. Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2007, 25(29): 4569-4574.
[26]	Guillem JG,Chessin DB,Cohen AM, et al. Long-term oncologic outcome following preoperative combined modality therapy and total mesorectal excision of locally advanced rectal cancer[J]. Annals of surgery, 2005, 241(5): 829-836; discussion 836-828.

分级	Mandard^［3］（5分类）	Mandard^［3］（3分类）	Becker^［1］	Dowrak/Rodel^［2］（5分类）	Dowrak/Rodel^［2］（3分类）	MSKCC^［6］	AJCC^［7］	RCRG^［5］
TRG0	?	?	?	没有退缩	?	?	无残余	?
TRG1	无肿瘤残余	无肿瘤残余	TRG1a无残余	纤维化<25%	完全退缩	无肿瘤残余	稀少残余	明显纤维化，几乎无或少量肿瘤残余
TRG1	无肿瘤残余	无肿瘤残余	TRG1b <10%肿瘤残余	纤维化<25%	完全退缩	无肿瘤残余	稀少残余	明显纤维化，几乎无或少量肿瘤残余
TRG2	稀少残余	稀少残余或纤维化多于肿瘤	10%~50%肿瘤残余	纤维化约25%~50%	纤维化约25%~99%	86%~99%肿瘤退缩	?	大体可见残余，镜下明显纤维化
TRG3	纤维化多于肿瘤	肿瘤多于纤维化	>50%肿瘤残余	纤维化>50%	纤维化<25%或无退缩	<85%肿瘤退缩	?	大体明显残留，纤维化少
TRG4	肿瘤多于纤维化	?	?	完全退缩	?	?	?	?
TRG5	侵袭性表现	?	?	?	?	?	?	?

分级	Mandard^［3］（5分类）	Mandard^［3］（3分类）	Becker^［1］	Dowrak/Rodel^［2］（5分类）	Dowrak/Rodel^［2］（3分类）	MSKCC^［6］	AJCC^［7］	RCRG^［5］
TRG0	?	?	?	没有退缩	?	?	无残余	?
TRG1	无肿瘤残余	无肿瘤残余	TRG1a无残余	纤维化<25%	完全退缩	无肿瘤残余	稀少残余	明显纤维化，几乎无或少量肿瘤残余
TRG1	无肿瘤残余	无肿瘤残余	TRG1b <10%肿瘤残余	纤维化<25%	完全退缩	无肿瘤残余	稀少残余	明显纤维化，几乎无或少量肿瘤残余
TRG2	稀少残余	稀少残余或纤维化多于肿瘤	10%~50%肿瘤残余	纤维化约25%~50%	纤维化约25%~99%	86%~99%肿瘤退缩	?	大体可见残余，镜下明显纤维化
TRG3	纤维化多于肿瘤	肿瘤多于纤维化	>50%肿瘤残余	纤维化>50%	纤维化<25%或无退缩	<85%肿瘤退缩	?	大体明显残留，纤维化少
TRG4	肿瘤多于纤维化	?	?	完全退缩	?	?	?	?
TRG5	侵袭性表现	?	?	?	?	?	?	?

Please choose a citation manager

Content to export