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Tumor regression grading scale predicted long-term outcomes in rectal carcinoma

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A three-tier tumor regression grading scale effectively predicted risk for distant metastases and DFS after neoadjuvant chemoradiotherapy and total mesorectal excision surgery in patients with rectal carcinoma, according to study results.

Emmanouil Fokas, MD, DPhil, of the department of radiotherapy and oncology at the University of Frankfurt in Germany, and colleagues previously reported data on the prognostic impact of tumor regression grading on outcomes in a cohort of patients included in the CAO/ARO/AIO-94 trial treated with preoperative chemoradiotherapy for rectal carcinoma.

In the current study, Fokas and colleagues report on the data for 386 surgical specimens. Median follow-up was 132 months.

Cumulative 10-year incidence of distant metastases was 10.5% among patients with complete tumor regression, 29.3% among those with intermediate regression, and 39.6% among those with poor regression (P=.005).

Ten-year DFS was 89.5% among patients with complete tumor regression, 73.6% among those with intermediate regression, and 63% among patients with poor regression (P=.008).

Local recurrence was significantly affected by residual lymph node metastasis status (P<.001) and lymphatic invasion (P=.026). Residual lymph node metastasis status and tumor regression grading were the only independent prognostic factors for the cumulative incidence of distant metastasis (P<.001 and P=.035, respectively) and DFS (P<.001 and P=.039, respectively).

“This classification system needs to be prospectively tested in multiple data sets to validate its reproducibility in a wider setting,” the researchers wrote.

The data offer “solid evidence” demonstrating the independent prognostic value of tumor regression grading among patients with rectal cancer who undergo preoperative chemoradiotherapy, Vincenzo Valentini, MD, of the Policlinico A. Gemelli–Universita Cattolica S. Cuore in Rome, and Bruce D. Minsky, MD, of The University of Texas MD Anderson Cancer Center, wrote in an accompanying editorial.

“However, the prognostic and predictive significance of tumor regression grading is still affected by uncertainties such as limited end points and the quality and heterogeneity of histological data,” Valentini and Minsky wrote. “There are opportunities for future trials to examine the impact of tumor regression grading on specific relevant-to-the-patient goals, such as reduction of surgery extent or need for adjuvant therapies. These trials will require stratification according to pretreatment staging and sphincter function, quality of life and the type of neoadjuvant therapy. When available, large databases may offer some guidance as to the prognostic and predictive impact of tumor regression grading. While we await these additional studies, tumor regression grading provides a valuable tool to assist in clinical decision making.”

For more information:

• Fokas E. J Clin Oncol. 2014;doi:10.1200/JCO.2013.54.3769.
• Valentini V. J Clin Oncol. 2014;doi:10.1200/JCO.2013.54.3769.

Disclosure: The researchers report honoraria from F. Hoffmann-La Roche and Sanofi-Aventis, and research funding from Roche. Valentini and Minsky report no relevant financial disclosures.