Tumor regression grade as a clinically useful outcome predictor in patients with rectal cancer after preoperative chemoradiotherapy

Abstract

The prognostic role of tumor regression grade is not clear. This study evaluated the prognostic significance of tumor regression grade in patients with rectal cancer after preoperative chemoradiotherapy. A total of 639 patients with confirmed rectal cancer who had undergone preoperative chemoradiotherapy and radical resection during the period October 2002 through December 2011 were included in this study. The tumor regression grade was graded: TRG0 (complete response), TRG1 (moderate), TRG2 (minimal), and TRG3 (poor). The prognostic significance of tumor regression grade was evaluated. With a median follow-up of 56.7 months, the rates of 5-year overall survival, disease-free survival, and local recurrence-free survival among the TRG groups differed significantly (all P < .001). For patients with TRG0, TRG1, and TRG2-3, disease-free survivals were different between the ypStage (P < .001, P < .001, and P = .043). Multivariate analysis revealed findings to substantiate that the tumor regression grade represents a valuable and independent prognostic factor for long-term, disease-free survival (P = .041). Independent predictors of TRG2-3 consisted of lymphovascular invasion, tumor budding, and the pretreatment serum level of carcinoembryonic antigen in multivariate regression analysis. Clinical risk grouping, using 3 predictors for TRG2-3 was different (P < .001). The tumor regression grade may represent a useful prognostic variable to better individualize the prognosis and potentially further therapy for each rectal cancer patient who underwent chemoradiotherapy.