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Tumor Regression Grade in Gastric Cancer After Preoperative Therapy
Background The Cancer Staging Manual , 8th edition, now includes post-neoadjuvant therapy (ypTNM) staging for gastric cancer patients. Our purpose was to determine whether the tumor regression grade (TRG) of the primary tumor is useful for predicting the survival of these patients. Methods We perfor...
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| Published in: | Journal of gastrointestinal surgery 2021-06, Vol.25 (6), p.1380-1387 |
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| container_title | Journal of gastrointestinal surgery |
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| creator | Ikoma, Naruhiko Estrella, Jeannelyn S. Blum Murphy, Mariela Das, Prajnan Minsky, Bruce D. Mansfield, Paul Ajani, Jaffer A. Badgwell, Brian D. |
| description | Background
The
Cancer Staging Manual
, 8th edition, now includes post-neoadjuvant therapy (ypTNM) staging for gastric cancer patients. Our purpose was to determine whether the tumor regression grade (TRG) of the primary tumor is useful for predicting the survival of these patients.
Methods
We performed a retrospective review of an institutional database and identified patients with clinically non-metastatic gastric adenocarcinoma who underwent preoperative chemotherapy or chemoradiation therapy before gastrectomy. Pathology reports were reviewed, and TRG was classified as follows: 0 (complete response), 1 (viable tumor cells ≤ 1–2%), 2 (viable cells ≤ 50%), or 3 (viable cells > 50%).
Results
Of the 356 patients identified, including 80 (23%) with a gastroesophageal junction tumor, 268 (75%) had undergone preoperative chemoradiation therapy. Fifty-six (16%) had TRG 0, 57 (16%) TRG 1, 128 (36%) TRG 2, and 115 (32%) TRG 3. No association between TRG and pretreatment factors was identified, except for signet-ring cell histologic type and tumor location. A higher TRG was associated with more advanced ypT and ypN categories (both
p
|
| doi_str_mv | 10.1007/s11605-020-04688-2 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_journals_2540613387</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2540613387</sourcerecordid><originalsourceid>FETCH-LOGICAL-c375t-8ab42fa745d91c70506a9a597aeb2d755a810e1aa061b838f90fdc983b5ddea93</originalsourceid><addsrcrecordid>eNp9kFFLwzAUhYMobk7_gA9S8Dl6kzRN-jiKTmGgyATfQtrezg7X1qQV9u-NduqbL8khOedc7kfIOYMrBqCuPWMJSAocKMSJ1pQfkCnTStA44clh0JAyyqV8mZAT7zcATAHTx2QiuIzDezIl2WrYti56wrVD7-u2iRbOlhjVQVjfu7qIMtsU6KJ51Yfz0WHbobN9_YHR6jWobndKjir75vFsf8_I8-3NKrujy4fFfTZf0kIo2VNt85hXVsWyTFmhQEJiUytTZTHnpZLSagbIrIWE5VroKoWqLFItclmWaFMxI5djb-fa9wF9bzbt4Jow0oR9QkqIsPyM8NFVuNZ7h5XpXL21bmcYmC9uZuRmAjfzzc3wELrYVw_5FsvfyA-oYBCjwYevZo3ub_Y_tZ-6sXew</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2540613387</pqid></control><display><type>article</type><title>Tumor Regression Grade in Gastric Cancer After Preoperative Therapy</title><source>Springer Nature</source><creator>Ikoma, Naruhiko ; Estrella, Jeannelyn S. ; Blum Murphy, Mariela ; Das, Prajnan ; Minsky, Bruce D. ; Mansfield, Paul ; Ajani, Jaffer A. ; Badgwell, Brian D.</creator><creatorcontrib>Ikoma, Naruhiko ; Estrella, Jeannelyn S. ; Blum Murphy, Mariela ; Das, Prajnan ; Minsky, Bruce D. ; Mansfield, Paul ; Ajani, Jaffer A. ; Badgwell, Brian D.</creatorcontrib><description>Background
The
Cancer Staging Manual
, 8th edition, now includes post-neoadjuvant therapy (ypTNM) staging for gastric cancer patients. Our purpose was to determine whether the tumor regression grade (TRG) of the primary tumor is useful for predicting the survival of these patients.
Methods
We performed a retrospective review of an institutional database and identified patients with clinically non-metastatic gastric adenocarcinoma who underwent preoperative chemotherapy or chemoradiation therapy before gastrectomy. Pathology reports were reviewed, and TRG was classified as follows: 0 (complete response), 1 (viable tumor cells ≤ 1–2%), 2 (viable cells ≤ 50%), or 3 (viable cells > 50%).
Results
Of the 356 patients identified, including 80 (23%) with a gastroesophageal junction tumor, 268 (75%) had undergone preoperative chemoradiation therapy. Fifty-six (16%) had TRG 0, 57 (16%) TRG 1, 128 (36%) TRG 2, and 115 (32%) TRG 3. No association between TRG and pretreatment factors was identified, except for signet-ring cell histologic type and tumor location. A higher TRG was associated with more advanced ypT and ypN categories (both
p
< 0.001), ypM1 (
p
= 0.004), and R1 resection (
p
= 0.052). The median overall survival (OS) duration was 6.6 years, and the 5-year OS rate was 54.1%. TRG 3 was associated with a shorter OS duration than were other TRG scores (
p
= 0.015), while the OS did not differ significantly among the TRG 0–2 groups (
p
= 0.803). On multivariable analysis, TRG was not associated with OS after adjustment for ypN status.
Conclusion
In gastric cancer patients who underwent preoperative therapy, TRG 3 was associated with advanced ypStage and R1 resection. Patients with TRG 3 had a shorter OS duration because of associated advanced ypStage, particularly ypN+ status.</description><identifier>ISSN: 1091-255X</identifier><identifier>EISSN: 1873-4626</identifier><identifier>DOI: 10.1007/s11605-020-04688-2</identifier><identifier>PMID: 32542556</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Adenocarcinoma - pathology ; Adenocarcinoma - therapy ; Cancer therapies ; Chemotherapy ; Ethnicity ; Gastric cancer ; Gastroenterology ; Gastrointestinal surgery ; Humans ; Lymphatic system ; Medicine ; Medicine & Public Health ; Metastasis ; Neoadjuvant Therapy ; Neoplasm Staging ; Oncology ; Original Article ; Pathology ; Prognosis ; Radiation ; Retrospective Studies ; Stomach Neoplasms - pathology ; Stomach Neoplasms - therapy ; Surgery ; Tumors</subject><ispartof>Journal of gastrointestinal surgery, 2021-06, Vol.25 (6), p.1380-1387</ispartof><rights>The Society for Surgery of the Alimentary Tract 2020</rights><rights>The Society for Surgery of the Alimentary Tract 2020.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-8ab42fa745d91c70506a9a597aeb2d755a810e1aa061b838f90fdc983b5ddea93</citedby><cites>FETCH-LOGICAL-c375t-8ab42fa745d91c70506a9a597aeb2d755a810e1aa061b838f90fdc983b5ddea93</cites><orcidid>0000-0002-9825-9234</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32542556$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ikoma, Naruhiko</creatorcontrib><creatorcontrib>Estrella, Jeannelyn S.</creatorcontrib><creatorcontrib>Blum Murphy, Mariela</creatorcontrib><creatorcontrib>Das, Prajnan</creatorcontrib><creatorcontrib>Minsky, Bruce D.</creatorcontrib><creatorcontrib>Mansfield, Paul</creatorcontrib><creatorcontrib>Ajani, Jaffer A.</creatorcontrib><creatorcontrib>Badgwell, Brian D.</creatorcontrib><title>Tumor Regression Grade in Gastric Cancer After Preoperative Therapy</title><title>Journal of gastrointestinal surgery</title><addtitle>J Gastrointest Surg</addtitle><addtitle>J Gastrointest Surg</addtitle><description>Background
The
Cancer Staging Manual
, 8th edition, now includes post-neoadjuvant therapy (ypTNM) staging for gastric cancer patients. Our purpose was to determine whether the tumor regression grade (TRG) of the primary tumor is useful for predicting the survival of these patients.
Methods
We performed a retrospective review of an institutional database and identified patients with clinically non-metastatic gastric adenocarcinoma who underwent preoperative chemotherapy or chemoradiation therapy before gastrectomy. Pathology reports were reviewed, and TRG was classified as follows: 0 (complete response), 1 (viable tumor cells ≤ 1–2%), 2 (viable cells ≤ 50%), or 3 (viable cells > 50%).
Results
Of the 356 patients identified, including 80 (23%) with a gastroesophageal junction tumor, 268 (75%) had undergone preoperative chemoradiation therapy. Fifty-six (16%) had TRG 0, 57 (16%) TRG 1, 128 (36%) TRG 2, and 115 (32%) TRG 3. No association between TRG and pretreatment factors was identified, except for signet-ring cell histologic type and tumor location. A higher TRG was associated with more advanced ypT and ypN categories (both
p
< 0.001), ypM1 (
p
= 0.004), and R1 resection (
p
= 0.052). The median overall survival (OS) duration was 6.6 years, and the 5-year OS rate was 54.1%. TRG 3 was associated with a shorter OS duration than were other TRG scores (
p
= 0.015), while the OS did not differ significantly among the TRG 0–2 groups (
p
= 0.803). On multivariable analysis, TRG was not associated with OS after adjustment for ypN status.
Conclusion
In gastric cancer patients who underwent preoperative therapy, TRG 3 was associated with advanced ypStage and R1 resection. Patients with TRG 3 had a shorter OS duration because of associated advanced ypStage, particularly ypN+ status.</description><subject>Adenocarcinoma - pathology</subject><subject>Adenocarcinoma - therapy</subject><subject>Cancer therapies</subject><subject>Chemotherapy</subject><subject>Ethnicity</subject><subject>Gastric cancer</subject><subject>Gastroenterology</subject><subject>Gastrointestinal surgery</subject><subject>Humans</subject><subject>Lymphatic system</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Metastasis</subject><subject>Neoadjuvant Therapy</subject><subject>Neoplasm Staging</subject><subject>Oncology</subject><subject>Original Article</subject><subject>Pathology</subject><subject>Prognosis</subject><subject>Radiation</subject><subject>Retrospective Studies</subject><subject>Stomach Neoplasms - pathology</subject><subject>Stomach Neoplasms - therapy</subject><subject>Surgery</subject><subject>Tumors</subject><issn>1091-255X</issn><issn>1873-4626</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNp9kFFLwzAUhYMobk7_gA9S8Dl6kzRN-jiKTmGgyATfQtrezg7X1qQV9u-NduqbL8khOedc7kfIOYMrBqCuPWMJSAocKMSJ1pQfkCnTStA44clh0JAyyqV8mZAT7zcATAHTx2QiuIzDezIl2WrYti56wrVD7-u2iRbOlhjVQVjfu7qIMtsU6KJ51Yfz0WHbobN9_YHR6jWobndKjir75vFsf8_I8-3NKrujy4fFfTZf0kIo2VNt85hXVsWyTFmhQEJiUytTZTHnpZLSagbIrIWE5VroKoWqLFItclmWaFMxI5djb-fa9wF9bzbt4Jow0oR9QkqIsPyM8NFVuNZ7h5XpXL21bmcYmC9uZuRmAjfzzc3wELrYVw_5FsvfyA-oYBCjwYevZo3ub_Y_tZ-6sXew</recordid><startdate>20210601</startdate><enddate>20210601</enddate><creator>Ikoma, Naruhiko</creator><creator>Estrella, Jeannelyn S.</creator><creator>Blum Murphy, Mariela</creator><creator>Das, Prajnan</creator><creator>Minsky, Bruce D.</creator><creator>Mansfield, Paul</creator><creator>Ajani, Jaffer A.</creator><creator>Badgwell, Brian D.</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><orcidid>https://orcid.org/0000-0002-9825-9234</orcidid></search><sort><creationdate>20210601</creationdate><title>Tumor Regression Grade in Gastric Cancer After Preoperative Therapy</title><author>Ikoma, Naruhiko ; Estrella, Jeannelyn S. ; Blum Murphy, Mariela ; Das, Prajnan ; Minsky, Bruce D. ; Mansfield, Paul ; Ajani, Jaffer A. ; Badgwell, Brian D.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-8ab42fa745d91c70506a9a597aeb2d755a810e1aa061b838f90fdc983b5ddea93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Adenocarcinoma - pathology</topic><topic>Adenocarcinoma - therapy</topic><topic>Cancer therapies</topic><topic>Chemotherapy</topic><topic>Ethnicity</topic><topic>Gastric cancer</topic><topic>Gastroenterology</topic><topic>Gastrointestinal surgery</topic><topic>Humans</topic><topic>Lymphatic system</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Metastasis</topic><topic>Neoadjuvant Therapy</topic><topic>Neoplasm Staging</topic><topic>Oncology</topic><topic>Original Article</topic><topic>Pathology</topic><topic>Prognosis</topic><topic>Radiation</topic><topic>Retrospective Studies</topic><topic>Stomach Neoplasms - pathology</topic><topic>Stomach Neoplasms - therapy</topic><topic>Surgery</topic><topic>Tumors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ikoma, Naruhiko</creatorcontrib><creatorcontrib>Estrella, Jeannelyn S.</creatorcontrib><creatorcontrib>Blum Murphy, Mariela</creatorcontrib><creatorcontrib>Das, Prajnan</creatorcontrib><creatorcontrib>Minsky, Bruce D.</creatorcontrib><creatorcontrib>Mansfield, Paul</creatorcontrib><creatorcontrib>Ajani, Jaffer A.</creatorcontrib><creatorcontrib>Badgwell, Brian D.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>ProQuest Nursing and Allied Health Journals</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>AUTh Library subscriptions: ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><jtitle>Journal of gastrointestinal surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ikoma, Naruhiko</au><au>Estrella, Jeannelyn S.</au><au>Blum Murphy, Mariela</au><au>Das, Prajnan</au><au>Minsky, Bruce D.</au><au>Mansfield, Paul</au><au>Ajani, Jaffer A.</au><au>Badgwell, Brian D.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Tumor Regression Grade in Gastric Cancer After Preoperative Therapy</atitle><jtitle>Journal of gastrointestinal surgery</jtitle><stitle>J Gastrointest Surg</stitle><addtitle>J Gastrointest Surg</addtitle><date>2021-06-01</date><risdate>2021</risdate><volume>25</volume><issue>6</issue><spage>1380</spage><epage>1387</epage><pages>1380-1387</pages><issn>1091-255X</issn><eissn>1873-4626</eissn><abstract>Background
The
Cancer Staging Manual
, 8th edition, now includes post-neoadjuvant therapy (ypTNM) staging for gastric cancer patients. Our purpose was to determine whether the tumor regression grade (TRG) of the primary tumor is useful for predicting the survival of these patients.
Methods
We performed a retrospective review of an institutional database and identified patients with clinically non-metastatic gastric adenocarcinoma who underwent preoperative chemotherapy or chemoradiation therapy before gastrectomy. Pathology reports were reviewed, and TRG was classified as follows: 0 (complete response), 1 (viable tumor cells ≤ 1–2%), 2 (viable cells ≤ 50%), or 3 (viable cells > 50%).
Results
Of the 356 patients identified, including 80 (23%) with a gastroesophageal junction tumor, 268 (75%) had undergone preoperative chemoradiation therapy. Fifty-six (16%) had TRG 0, 57 (16%) TRG 1, 128 (36%) TRG 2, and 115 (32%) TRG 3. No association between TRG and pretreatment factors was identified, except for signet-ring cell histologic type and tumor location. A higher TRG was associated with more advanced ypT and ypN categories (both
p
< 0.001), ypM1 (
p
= 0.004), and R1 resection (
p
= 0.052). The median overall survival (OS) duration was 6.6 years, and the 5-year OS rate was 54.1%. TRG 3 was associated with a shorter OS duration than were other TRG scores (
p
= 0.015), while the OS did not differ significantly among the TRG 0–2 groups (
p
= 0.803). On multivariable analysis, TRG was not associated with OS after adjustment for ypN status.
Conclusion
In gastric cancer patients who underwent preoperative therapy, TRG 3 was associated with advanced ypStage and R1 resection. Patients with TRG 3 had a shorter OS duration because of associated advanced ypStage, particularly ypN+ status.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>32542556</pmid><doi>10.1007/s11605-020-04688-2</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-9825-9234</orcidid></addata></record> |
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| source | Springer Nature |
| subjects | Adenocarcinoma - pathology Adenocarcinoma - therapy Cancer therapies Chemotherapy Ethnicity Gastric cancer Gastroenterology Gastrointestinal surgery Humans Lymphatic system Medicine Medicine & Public Health Metastasis Neoadjuvant Therapy Neoplasm Staging Oncology Original Article Pathology Prognosis Radiation Retrospective Studies Stomach Neoplasms - pathology Stomach Neoplasms - therapy Surgery Tumors |
| title | Tumor Regression Grade in Gastric Cancer After Preoperative Therapy |
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