30. Tumor regression grade in rectal adenocarcinoma after neoadjuvant chemoradiotherapy: A histopathological study
Main Article Content
Abstract
A cross-sectional descriptive study was conducted on 55 rectal adenocarcinoma patients who received NCRT followed by TME from January 2023 to October 2024 at Hanoi Medical University Hospital to evaluate tumor regression grade (TRG) rate and to examine the correlation between TRG and other clinic histopathological factors in patients who received neoadjuvant chemoradiotherapy (NCRT) followed by rectal excision. The mean age was 62.4 ± 10.2 years old. The male-to-female was 3.2:1. Poor regression of the primary tumor (TRG 0+1) was observed in 36.4%, intermediate regression (TRG 2+3) in 49.1% and complete regression (TRG 4) in 14.5%. Complete and intermediate response groups (TRG4 and TRG 2+3) were significantly associated with absence of vascular invasion (p = 0.01), nodal metastasis (p = 0.024). There was a significant inverse trend between TRG and ypT, ypN stage (p < 0.05).
Article Details
Keywords
Dworak tumor regression grade classification, neoadjuvant chemoradiotherapy, rectal adenocarcinoma
References
2. Diefenhardt M, Schlenska-Lange A, Kuhnt T, et al. Total Neoadjuvant Therapy for Rectal Cancer in the CAO/ARO/AIO-12 Randomized Phase 2 Trial: Early Surrogate Endpoints Revisited. Cancers. Jul 27 2022; 14(15). doi:10.3390/cancers14153658.
3. Hermanek P, Merkel S, Hohenberger W. Prognosis of rectal carcinoma after multimodal treatment: ypTNM classification and tumor regression grading are essential. Anticancer research. Feb 2013; 33(2): 559-66.
4. Karimi F, Tabriz HM, Amoli HA, Nazar E, Vaezi AA. Evaluation of the histopathologic status of rectal adenocarcinoma and its regional lymph nodes after neoadjuvant therapy, and its relation to the duration of disease-free survival. 2022; 65(1): 49-54. doi:10.4103/ijpm.Ijpm_1331_20.
5. Dworak O, Keilholz L, Hoffmann A. Pathological features of rectal cancer after preoperative radiochemotherapy. International journal of colorectal disease. 1997; 12(1): 19-23. doi:10.1007/s003840050072.
6. Fokas E, Ströbel P, Fietkau R, et al. Tumor Regression Grading After Preoperative Chemoradiotherapy as a Prognostic Factor and Individual-Level Surrogate for Disease-Free Survival in Rectal Cancer. JNCI: Journal of the National Cancer Institute. 2017; 109(12): djx095. doi:10.1093/jnci/djx095
7. Mihaylova I, Parvanova V, Velikova C, Kurteva G, Ivanova D. Degree of tumor regression after preoperative chemo-radiotherapy in locally advanced rectal cancer-Preliminary results. Reports of practical oncology and radiotherapy : journal of Greatpoland Cancer Center in Poznan and Polish Society of Radiation Oncology. 2011; 16(6): 237-42. doi:10.1016/j.rpor.2011.06.008.
8. Glynne-Jones R, Wyrwicz L, Tiret E, et al. Rectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up†. Annals of Oncology. 2017/07/01/ 2017; 28: iv22-iv40. doi:https://doi.org/10.1093/annonc/mdx224.
9. Fokas E, Liersch T, Fietkau R, et al. Tumor Regression Grading After Preoperative Chemoradiotherapy for Locally Advanced Rectal Carcinoma Revisited: Updated Results of the CAO/ARO/AIO-94 Trial. Journal of Clinical Oncology. 2014/05/20 2014; 32(15): 1554-1562. doi:10.1200/JCO.2013.54.3769.
10. Breugom AJ, Swets M, Bosset JF, et al. Adjuvant chemotherapy after preoperative (chemo)radiotherapy and surgery for patients with rectal cancer: a systematic review and meta-analysis of individual patient data. The Lancet Oncology. Feb 2015; 16(2): 200-7. doi:10.1016/s1470-2045(14)71199-4.
11. Aliyarov Y. Predictive Factors in Tumor Response for Neoadjuvant Chemoradiotherapy in Rectal Cancer Patients. In: Vannelli A, ed. Diseases of the Rectum and Anus - A Concise Guide. IntechOpen; 2025.
12. Zhou J, Sun Y, Xiao L, et al. Prognosis and influencing factors of patients with different lymph node statuses after pathological complete response to neoadjuvant chemoradiotherapy in rectal cancer. Oncology letters. Jul 2025; 30(1): 359. doi:10.3892/ol.2025.15105.
13. Scott AJ, Kennedy EB, Berlin J, et al. Management of Locally Advanced Rectal Cancer: ASCO Guideline. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. Oct 2024; 42(28): 3355-3375. doi:10.1200/jco.24.01160.
14. Ammendola S, Caldonazzi N, Rizzo PC, Turri G, Pedrazzani C, Barresi V. H3K27me3 Immunohistochemical Loss Predicts Lower Response to Neo-Adjuvant Chemo-Radiotherapy in Rectal Carcinoma. Biomedicines. 2022; 10(8): 2042. doi:10.3390/biomedicines10082042 Accessed 2022/08//.