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Tumor Regression Grade in Gastric Cancer After Preoperative Therapy

  • Original Article
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Journal of Gastrointestinal Surgery Aims and scope

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.

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Acknowledgments

The authors thank Ann Sutton in the Department of Scientific Publications at MD Anderson for editing this manuscript.

Funding

This study was supported in part by the US National Institutes of Health under Cancer Center Support Grant P30 CA016672; the Clinical Trials Support Resource was used.

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Authors and Affiliations

  1. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Naruhiko Ikoma, Paul Mansfield & Brian D. Badgwell

  2. Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Jeannelyn S. Estrella

  3. Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Mariela Blum Murphy & Jaffer A. Ajani

  4. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Prajnan Das & Bruce D. Minsky

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  1. Naruhiko Ikoma
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Correspondence to Naruhiko Ikoma.

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This manuscript was selected for oral presentation at the Society of Surgical Oncology Annual Cancer Symposium (March 28, 2019, San Diego, CA).

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Ikoma, N., Estrella, J.S., Blum Murphy, M. et al. Tumor Regression Grade in Gastric Cancer After Preoperative Therapy. J Gastrointest Surg 25, 1380–1387 (2021). https://doi.org/10.1007/s11605-020-04688-2

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