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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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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DOI: https://doi.org/10.1007/s11605-020-04688-2