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International Journal of Colorectal Disease
Published in: International Journal of Colorectal Disease 10/2012

01-10-2012 | Original Article

Evaluation of histological regression grading systems in the neoadjuvant therapy of rectal cancer

Do they have prognostic impact?

Authors: D. Vallböhmer, E. Bollschweiler, J. Brabender, I. Wedemeyer, P. P. Grimminger, R. Metzger, W. Schröder, C. Gutschow, A. H. Hölscher, U. Drebber

Published in: International Journal of Colorectal Disease | Issue 10/2012

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Abstract

Purpose

Neoadjuvant treatment options have been developed to improve survival of patients with locally advanced rectal cancer. As only patients with a major histopatholocial response benefit from this preoperative therapy, several tumor regression grading systems have been developed. However, currently no accepted comprehensive grading system for clinical use is available. Therefore, we studied the impact of four histological regression grading systems in the neoadjuvant therapy of rectal cancer.

Methods

In this retrospective study, 85 patients with locally advanced rectal cancer were included. All patients received a neoadjuvant radiochemotherapy followed by surgical resection. The histological regression grading was evaluated using four classification systems: (1) grading system by the Japanese society of colorectal cancer, (2) grading system by Junker–Müller, (3) grading system by Dworak, (4) Cologne grading system. The four classification systems were analyzed for their prognostic impact.

Results

The following significant correlations were detected between the four classification systems and the ypTNM categories: (1) patients with a ypT3/4 category had significantly more often a worse histopathologic response in all four grading systems (p = 0.001); (2) a ypN0 category was significantly correlated with good histopathologic response only in the Cologne grading system; (3) in the Junker–Müller and Dworak grading systems, a ypM0 category was significantly correlated with a good histopathologic response (p = 0.046; p = 0.03). However, none of the used classification systems had a prognostic impact on survival.

Conclusions

Currently, none of the analyzed histological regression grading systems is effective for clinical use.
Literature
1.
Sauer R, Becker H, Hohenberger W et al (2004) Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 351:1731–1740PubMedCrossRef
2.
Bosset JF, Collette L, Calais G et al (2006) Chemotherapy with preoperative radiotherapy in rectal cancer. N Engl J Med 355:1114–1123PubMedCrossRef
3.
Gerard JP, Conroy T, Bonnetain F et al (2006) Preoperative radiotherapy with or without concurrent fluorouracil and leucovorin in T3–4 rectal cancers: results of FFCD 9203. J Clin Oncol 24:4620–4625PubMedCrossRef
4.
Rödel C, Martus P, Papadoupolos T et al (2005) Prognostic significance of tumor regression after preoperative chemoradiotherapy for rectal cancer. J Clin Oncol 23:8688–8696PubMedCrossRef
5.
Guillem JG, Chessin DB, Cohen AM et al (2005) Long-term oncologic outcome following preoperative combined modality therapy and total mesorectal excision of locally advanced rectal cancer. Ann Surg 241:829–836PubMedCrossRef
6.
Beddy D, Hyland JM, Winter DC et al (2008) A simplified tumor regression grade correlates with survival in locally advanced rectal carcinoma treated with neoadjuvant chemoradiotherapy. Ann Surg Oncol 15:3471–3477PubMedCrossRef
7.
Yeo SG, Kim DY, Kim TH (2010) Pathologic complete response of primary tumor following preoperative chemoradiotherapy for locally advanced rectal cancer: long-term outcomes and prognostic significance of pathologic nodal status (KROG 09–01). Ann Surg 252:998–1004PubMedCrossRef
8.
Japanese Society for Cancer of the Colon and Rectum (JSCCR). Japanese classification of colorectal carcinoma 1997, 1st English edn. Kanehara & Co, Tokyo
9.
Junker K, Thomas M, Schulmann K et al (1997) Tumour regression in non-small-cell lung cancer following neoadjuvant therapy. Histological assessment. J Cancer Res Clin Oncol 123:469–477PubMedCrossRef
10.
Dworak O, Keilholz L, Hoffmann A (1997) Pathological features of rectal cancer after preoperative radiochemotherapy. Int J Colorectal Dis 12:19–23PubMedCrossRef
11.
Schneider PM, Baldus SE, Metzger R et al (2005) Histomorphologic tumor regression and lymph node metastases determine prognosis following neoadjuvant radiochemotherapy for esophageal cancer: implications for response classification. Ann Surg 242:684–692PubMedCrossRef
12.
Pucciarelli S, Toppan P, Friso ML et al (2004) Complete pathologic response following preoperative chemoradiation therapy for middle to lower rectal cancer is not a prognostic factor for a better outcome. Dis Colon Rectum 47:1798–1807PubMedCrossRef
13.
Jakob C, Liersch T, Meyer W et al (2006) Prognostic value of histologic tumor regression, thymidylate synthase, thymidine phosphorylase, and dihydropyrimidine dehydrogenase in rectal cancer UICC Stage II/III after neoadjuvant chemoradiotherapy. Am J Surg Pathol 30:1169–1174PubMed
14.
Kaplan E, Meier P (1958) Nonparametric estimation from incomplete observations. J Am Stat Assoc 53:457–481CrossRef
15.
Pocock SJ, Clayton TC, Altman DG (2002) Survival plots of time-to-event outcomes in clinical trials: good practice and pitfalls. Lancet 359:1686–1689PubMedCrossRef
16.
Horisberger K, Hofheinz RD, Palma P et al (2008) Tumor response to neoadjuvant chemoradiation in rectal cancer: predictor for surgical morbidity? Int J Colorectal Dis 23:257–264PubMedCrossRef
17.
Tsujinaka S, Kawamura YJ, Konishi F et al (2008) Long-term efficacy of preoperative radiotherapy for locally advanced rectal cancer. Int J Colorectal Dis 23:67–76PubMedCrossRef
Metadata
Title
Evaluation of histological regression grading systems in the neoadjuvant therapy of rectal cancer
Do they have prognostic impact?
Authors
D. Vallböhmer
E. Bollschweiler
J. Brabender
I. Wedemeyer
P. P. Grimminger
R. Metzger
W. Schröder
C. Gutschow
A. H. Hölscher
U. Drebber
Publication date
01-10-2012
Publisher
Springer-Verlag
Published in
International Journal of Colorectal Disease / Issue 10/2012
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI
https://doi.org/10.1007/s00384-012-1487-6

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