• Lu-Ning Zhang, Wei-Wei Xiao, Shao-Yan Xi, Pu-Yun OuYang, Kai-Yun You, Zhi-Fan Zeng, Pei-Rong Ding, Hui-Zhong Zhang, Zhi-Zhong Pan, Rui-Hua Xu, and Yuan-Hong Gao.
• From the Department of Radiation Oncology (L-NZ, W-WX, P-YOY, Z-FZ, Y-HG), Department of Colorectal Surgery (Z-ZP), Department of Medical Oncology (R-HX), and Department of Pathological Oncology (S-YX, H-ZZ), Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China; and Department of Oncology, The Second Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (K-YY).
• Medicine (Baltimore). 2016 Jan 1; 95 (3): e2272e2272.

AbstractWe used American Joint Committee on Cancer (AJCC) Staging Manual system to assess the prognostic significance of tumor regression grading (TRG) for locally advanced rectal cancer (LARC) (T3/4 or N+) patients who were treated with preoperative chemoradiotherapy (CRT).The 4 AJCC-TRG classifications were evaluated on surgical specimens from 295 LARC patients receiving CRT. Overall survival (OS), disease-free survival (DFS), local recurrence-free survival (LRFS), and distant metastasis-free survival (DMFS) were estimated using Kaplan-Meier method and Cox regression model.Classifications of TRG 0, 1, 2, and 3 were found in 27.5%, 19.3%, 45.7%, and 7.5% of the resected specimens, respectively. Three-year OS was 95.5% for TRG0, 91.5% for TRG1, 84.8% for TRG2, and 85.7% for TRG3 (P = 0.035). Three-year DFS was 89.0% for TRG0, 74.4% for TRG1, 70.9% for TRG2, and 62% for TRG3 (P = 0.018). By multivariate analysis, AJCC-TRG (P = 0.033), residual lymph node metastasis (ypN+) (P < 0.001) and pretreatment CA19-9 level (P = 0.035) were significant predictors of OS. Pathological T category (P = 0.006) and nodal status (P < 0.001) after CRT were the most important independent prognostic factors for DFS.AJCC-TRG is a prognostic factor for LARC patients receiving CRT, independent of pathological staging.

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