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International Journal of Colorectal Disease

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01-10-2006 | Original Article

Prognostic value of Dworak grade of regression (GR) in patients with rectal carcinoma treated with preoperative radiochemotherapy

Authors: Lorena Losi, Gabriele Luppi, Margherita Gavioli, Francesco Iachetta, Federica Bertolini, Roberto D’Amico, Gordana Jovic, Filippo Bertoni, Anna Maria Falchi, Pier Franco Conte

Published in: International Journal of Colorectal Disease | Issue 7/2006

Abstract

Background and aim

Preoperative radiochemotherapy improves local control in locally advanced rectal cancer; however, its role in prolonging survival is still controversial. In order to better define the subset in patients who might benefit from this multimodal treatment, we have evaluated the correlation between grade of regression (GR) to preoperative treatment and disease-free survival (DFS).

Methods

We reviewed retrospectively the surgical specimens of 106 patients with locally advanced T3/T4 N0/ M0 rectal cancer. All patients were treated preoperatively with radiotherapy and 5-fluorouracil-based regimen chemotherapy. We evaluated ypTNM stage, and tumor regression was graded using the Dworak system that varies from GR 0 (absence of regression) to GR 4 (complete regression).

Results

GR was as follows: GR 4, 16 patients (15%); GR 3, 25 patients (23.6%), GR 2, 30 patients (28.4%), GR 1, 32 patients (30.2%) and GR 0, 3 patients (2.8%). A significant correlation was found between GR and DFS. Three-year DFS was 100, 85, 82, 66 and 33% in GR 4, 3, 2, 1 and 0, respectively (p=0.01). DFS was significantly lower in patients with advanced stages at diagnosis and in patients without down-staging. Moreover, in postoperative stage II and III cases, GR 3 correlated with a better DFS than GR 2–0 (p=0.2 and p=0.4, respectively).

Conclusions

The GR was a significant prognostic factor in locally advanced rectal carcinoma treated with preoperative chemoradiotherapy. The pathological stage and down-staging also have prognostic value. The use of a standardized system to evaluate GR in rectal cancer can allow for comparisons between different institutions and can identify patients at worse prognosis to be treated with adjuvant therapy.

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Title: Prognostic value of Dworak grade of regression (GR) in patients with rectal carcinoma treated with preoperative radiochemotherapy
Authors: Lorena Losi
Gabriele Luppi
Margherita Gavioli
Francesco Iachetta
Federica Bertolini
Roberto D’Amico
Gordana Jovic
Filippo Bertoni
Anna Maria Falchi
Pier Franco Conte
Publication date: 01-10-2006
Publisher: Springer-Verlag
Published in: International Journal of Colorectal Disease / Issue 7/2006
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-005-0061-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Prognostic value of Dworak grade of regression (GR) in patients with rectal carcinoma treated with preoperative radiochemotherapy

Abstract

Background and aim

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background and aim

Methods

Results

Conclusions

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