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Tytuł pozycji:

Varying practices in tumor regression grading of gastrointestinal carcinomas after neoadjuvant therapy: results of an international survey.

Tytuł :
Varying practices in tumor regression grading of gastrointestinal carcinomas after neoadjuvant therapy: results of an international survey.
Autorzy :
Westerhoff M; Department of Pathology, University of Michigan, Ann Arbor, MI, USA.
Osecky M; Institute of Pathology, University of Bern, Bern, Switzerland.
Langer R; Institute of Pathology, University of Bern, Bern, Switzerland. .
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Źródło :
Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc [Mod Pathol] 2020 Apr; Vol. 33 (4), pp. 676-689. Date of Electronic Publication: 2019 Oct 31.
Typ publikacji :
Journal Article
Język :
Imprint Name(s) :
Publication: <2004- > : New York, NY : Nature Pub. Group
Original Publication: Baltimore, MD : Williams & Wilkins, c1988-
MeSH Terms :
Neoadjuvant Therapy*
Gastrointestinal Neoplasms/*pathology
Gastrointestinal Neoplasms/*therapy
Healthcare Disparities/*trends
Neoplasm Grading/*trends
Practice Patterns, Physicians'/*trends
Biopsy/trends ; Health Care Surveys ; Humans ; Predictive Value of Tests ; Remission Induction ; Staining and Labeling/trends ; Treatment Outcome
References :
Cunningham D, Allum WH, Stenning SP, Thompson JN, Van de Velde CJ, Nicolson M, et al. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med. 2006;355:11–20. (PMID: 10.1056/NEJMoa055531)
van Hagen P, Hulshof MC, van Lanschot JJ, Steyerberg EW, van Berge Henegouwen MI, Wijnhoven BP, et al. Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med. 2012;366:2074–84. (PMID: 10.1056/NEJMoa1112088)
Ychou M, Boige V, Pignon J-P, Conroy T, Bouché O, Lebreton G, et al. Perioperative chemotherapy compared with surgery alone for resectable gastroesophageal adenocarcinoma: a FNCLCC and FFCD multicenter phase III trial. J Clin Oncol. 2011;29:1715–21.
Rödel C, Liersch T, Becker H, Fietkau R, Hohenberger W, Hothorn T, et al. Preoperative chemoradiotherapy and postoperative chemotherapy with fluorouracil and oxaliplatin versus fluorouracil alone in locally advanced rectal cancer: initial results of the German CAO/ARO/AIO-04 randomised phase 3 trial. Lancet Oncol. 2012;13:679–87. (PMID: 10.1016/S1470-2045(12)70187-02262710422627104)
Roh MS, Colangelo LH, O’Connell MJ, Yothers G, Deutsch M, Allegra CJ, et al. Preoperative multimodality therapy improves disease-free survival in patients with carcinoma of the rectum: NSABP R-03. J Clin Oncol. 2009;27:5124–30. (PMID: 10.1200/JCO.2009.22.04671977037619770376)
Chirieac LR, Swisher SG, Ajani JA, Komaki RR, Correa AM, Morris JS, et al. Posttherapy pathologic stage predicts survival in patients with esophageal carcinoma receiving preoperative chemoradiation. Cancer. 2005;103:1347–55. (PMID: 10.1002/cncr.209161571944015719440)
Maas M, Nelemans PJ, Valentini V, Das P, Rodel C, Kuo LJ, et al. Long-term outcome in patients with a pathological complete response after chemoradiation for rectal cancer: a pooled analysis of individual patient data. Lancet Oncol. 2010;11:835–44. (PMID: 10.1016/S1470-2045(10)70172-82069287220692872)
Martin ST, Heneghan HM, Winter DC. Systematic review and meta-analysis of outcomes following pathological complete response to neoadjuvant chemoradiotherapy for rectal cancer. Br J Surg. 2012;99:918–28. (PMID: 10.1002/bjs.87022236200222362002)
Patel UB, Taylor F, Blomqvist L, George C, Evans H, Tekkis P, et al. Magnetic resonance imaging-detected tumor response for locally advanced rectal cancer predicts survival outcomes: MERCURY experience. J Clin Oncol. 2011;29:3753–60. (PMID: 10.1200/JCO.2011.34.90682187608421876084)
Damjanov I, O’Neil M. Histopathology of colorectal cancer after neoadjuvant chemoradiation therapy. Open Pathol J. 2009;3:91–8. (PMID: 10.2174/1874375700903020091)
Langer R, Ott K, Feith M, Lordick F, Siewert JR, Becker K. Prognostic significance of histopathological tumor regression after neoadjuvant chemotherapy in esophageal adenocarcinomas. Mod Pathol. 2009;22:1555–63. (PMID: 10.1038/modpathol.2009.1231980196719801967)
Becker K, Mueller JD, Schulmacher C, Ott K, Fink U, Busch R, et al. Histomorphology and grading of regression in gastric carcinoma treated with neoadjuvant chemotherapy. Cancer. 2003;98:1521–30. (PMID: 10.1002/cncr.116601450884114508841)
Chang F, Deere H, Mahadeva U, George S. Histopathologic examination and reporting of esophageal carcinomas following preoperative neoadjuvant therapy: practical guidelines and current issues. Am J Clin Path. 2008;129:252–62. (PMID: 10.1309/CCR3QN4874YJDJJ71820880618208806)
Dworak O, Keilholz L, Hoffmann A. Pathological features of rectal cancer after preoperative radiochemotherapy. Int J Colorectal Dis. 1997;12:19–23. (PMID: 10.1007/s00384005007291121459112145)
Mandard AM, Dalibard F, Mandard JC, Marnay J, Henry-Amar M, Petiot JF, et al. Pathologic assessment of tumor regression after preoperative chemoradiotherapy of esophageal carcinoma. Clinicopathologic correlations. Cancer 1994;73:2680–6. (PMID: 10.1002/1097-0142(19940601)73:11<2680::AID-CNCR2820731105>3.0.CO;2-C81940058194005)
Schneider PM, Baldus SE, Metzger R, Kocher M, Bongartz R, Bollschweiler E, et al. Histomorphologic tumor regression and lymph node metastases determine prognosis following neoadjuvant radiochemotherapy for esophageal cancer: implications for response classification. Ann Surg. 2005;242:684–92. (PMID: 10.1097/01.sla.0000186170.38348.7b1624454216244542)
Rödel C, Martus P, Papadoupolos T, Füzesi L, Klimpfinger M, Fietkau R, et al. Prognostic significance of tumor regression after preoperative chemoradiotherapy for rectal cancer. J Clin Oncol. 2005;23:8688–96. (PMID: 10.1200/JCO.2005.02.13291624697616246976)
Swisher SG, Hofstetter W, Wu TT, Correa AM, Ajani JA, Komaki RR, et al. Proposed revision of the esophageal cancer staging system to accommodate pathologic response (pP) following preoperative chemoradiation (CRT). Ann Surg. 2005;241:810–7. (PMID: 10.1097/01.sla.0000161983.82345.851584951715849517)
Rizk NP, Venkatraman E, Bains MS, Park B, Flores R, Tang L, et al. American Joint Committee on Cancer staging system does not accurately predict survival in patients receiving multimodality therapy for esophageal adenocarcinoma. J Clin Oncol. 2007;25:507–12. (PMID: 10.1200/JCO.2006.08.01011729005817290058)
Langer R, Becker K. Tumor regression grading of gastrointestinal cancers after neoadjuvant therapy. Virchows Arch. 2018;472:175–86. (PMID: 10.1007/s00428-017-2232-x2891854428918544)
Smyth EC, Fassan M, Cunningham D, Allum WH, Okines AF, Lampis A, et al. Effect of pathologic tumor response and nodal status on survival in the medical research council adjuvant gastric infusional chemotherapy trial. J Clin Oncol. 2016;34:2721–7. (PMID: 10.1200/JCO.2015.65.76922729841127298411)
Cunningham D, Stenning SP, Smyth EC, Okines AF, Allum WH, Rowley S, et al. Peri-operative chemotherapy with or without bevacizumab in operable oesophagogastric adenocarcinoma (UK Medical Research Council ST03): primary analysis results of a multicentre, open-label, randomised phase 2-3 trial. Lancet Oncol. 2017;18:357–70. (PMID: 10.1016/S1470-2045(17)30043-82816300028163000)
Fokas E, Strobel P, Fietkau R, Ghadimi M, Liersch T, Grabenbauer GG, et al. Tumor regression grading after preoperative chemoradiotherapy as a prognostic factor and individual-level surrogate for disease-free survival in rectal cancer. J Natl Cancer Inst. 2017;109:djx095.
Noble F, Lloyd MA, Turkington R, Griffiths E, O’Donovan M, O’Neill JR, et al. Multicentre cohort study to define and validate pathological assessment of response to neoadjuvant therapy in oesophagogastric adenocarcinoma. Br J Surg. 2017;104:1816–28. (PMID: 10.1002/bjs.106272894495428944954)
Alderson D, Cunningham D, Nankivell M, Blazeby JM, Griffin SM, Crellin A, et al. Neoadjuvant cisplatin and fluorouracil versus epirubicin, cisplatin, and capecitabine followed by resection in patients with oesophageal adenocarcinoma (UK MRC OE05): an open-label, randomised phase 3 trial. Lancet Oncol. 2017;18:1249–60. (PMID: 10.1016/S1470-2045(17)30447-32878431228784312)
Fareed KR, Kaye P, Soomro IN, Ilyas M, Martin S, Parsons SL, et al. Biomarkers of response to therapy in oesophago-gastric cancer. Gut. 2009;58:127–43. (PMID: 10.1136/gut.2008.1558611909183119091831)
Al-Batran SE, Hofheinz RD, Pauligk C, Kopp HG, Haag GM, Luley KB, et al. Histopathological regression after neoadjuvant docetaxel, oxaliplatin, fluorouracil, and leucovorin versus epirubicin, cisplatin, and fluorouracil or capecitabine in patients with resectable gastric or gastro-oesophageal junction adenocarcinoma (FLOT4-AIO): results from the phase 2 part of a multicentre, open-label, randomised phase 2/3 trial. Lancet Oncol. 2016;17:1697–1708. (PMID: 10.1016/S1470-2045(16)30531-92777684327776843)
Zhu Y, Sun Y, Hu S, Jiang Y, Yue J, Xue X, et al. Comparison of five tumor regression grading systems for gastric adenocarcinoma after neoadjuvant chemotherapy: a retrospective study of 192 cases from National Cancer Center in China. BMC Gastroenterol. 2017;17:41. (PMID: 10.1186/s12876-017-0598-52829227228292272)
Chetty R, Gill P, Govender D, Bateman A, Chang HJ, Driman D, et al. A multi-centre pathologist survey on pathological processing and regression grading of colorectal cancer resection specimens treated by neoadjuvant chemoradiation. Virchows Arch. 2012;460:151–5. (PMID: 10.1007/s00428-012-1193-32224118122241181)
Chetty R, Gill P, Govender D, Bateman A, Chang HJ, Deshpande V, et al. International study group on rectal cancer regression grading: interobserver variability with commonly used regression grading systems. Hum Pathol. 2012;43:1917–23. (PMID: 10.1016/j.humpath.2012.01.0202257526422575264)
Ryan R, Gibbons D, Hyland JMP, Treanor D, White A, Mulcahy HE, et al. Pathological response following long-course neoadjuvant chemoradiotherapy for locally advanced rectal cancer. Histopathology. 2005;47:141–6. (PMID: 10.1111/j.1365-2559.2005.02176.x1604577416045774)
Amin MB, Edge S, Greene F, Byrd DR, Brookland RK, Washington MK, et al. AJCC Cancer Staging Manual. 8th ed. Springer International Publishing, Chicago; 2017.
Japan Esophageal Society. Japanese Classification of Esophageal Cancer, 11th ed. part I. Esophagus. 2017;14:1–36.
Bateman AC, Jaynes E, Bateman AR. Rectal cancer staging post neoadjuvant therapy-how should the changes be assessed? Histopathology. 2009;54:713–21. (PMID: 10.1111/j.1365-2559.2009.03292.x1943874619438746)
Osecky M. Development of an international online survey to investigate the usage of tumor regression grading systems for gastrointestinal cancers after neoadjuvant therapy [Master Thesis]. Bern: University of Bern; 2019.
Le Scodan R, Mornex F, Partensky C, Mercier C, Valette PJ, Ychou M, et al. Histopathological response to preoperative chemoradiation for resectable pancreatic adenocarcinoma: the French Phase II FFCD 9704-SFRO Trial. Am J Clin Oncol. 2008;31:545–52. (PMID: 10.1097/COC.0b013e318172d5c51906058519060585)
Evans DB, Rich TA, Byrd DR, Cleary KR, Connelly JH, Levin B, et al. Preoperative chemoradiation and pancreaticoduodenectomy for adenocarcinoma of the pancreas. Arch Surg. 1992;127:1335–9. (PMID: 10.1001/archsurg.1992.0142011008301713598511359851)
Rubbia-Brandt L, Giostra E, Brezault C, Roth AD, Andres A, Audard V, et al. Importance of histological tumor response assessment in predicting the outcome in patients with colorectal liver metastases treated with neo-adjuvant chemotherapy followed by liver surgery. Ann Oncol. 2007;18:299–304. (PMID: 10.1093/annonc/mdl3861706048417060484)
College of the American Pathologists. 2017 [Available from: .
Wu TT, Chirieac LR, Abraham SC, Krasinskas AM, Wang H, Rashid A, et al. Excellent interobserver agreement on grading the extent of residual carcinoma after preoperative chemoradiation in esophageal and esophagogastric junction carcinoma: a reliable predictor for patient outcome. Am J Surg Pathol. 2007;31:58–64. (PMID: 10.1097/01.pas.0000213312.36306.cc1719791917197919)
Trakarnsanga A, Gonen M, Shia J, Nash GM, Temple LK, Guillem JG, et al. Comparison of tumor regression grade systems for locally advanced rectal cancer after multimodality treatment. J Natl Cancer Inst. 2014;106:dju248.
Mirza A, Naveed A, Hayes S, Formela L, Welch I, West CM, et al. Assessment of histopathological response in gastric and gastro-oesophageal junction adenocarcinoma following neoadjuvant chemotherapy: which scoring system to use? ISRN. Pathology. 2012;2012:8.
Karamitopoulou E, Thies S, Zlobec I, Ott K, Feith M, Slotta-Huspenina J, et al. Assessment of tumor regression of esophageal adenocarcinomas after neoadjuvant chemotherapy: comparison of 2 commonly used scoring approaches. Am J Surg Pathol. 2014;38:1551–6. (PMID: 10.1097/PAS.00000000000002552514089425140894)
Tomasello G, Petrelli F, Ghidini M, Pezzica E, Passalacqua R, Steccanella F, et al. Tumor regression grade and survival after neoadjuvant treatment in gastro-esophageal cancer: a meta-analysis of 17 published studies. Eur J Surg Oncol. 2017;43:1607–16. (PMID: 10.1016/j.ejso.2017.03.0012834752528347525)
Langer R, Becker K, Zlobec I, Gertler R, Sisic L, Buchler M, et al. A multifactorial histopathologic score for the prediction of prognosis of resected esophageal adenocarcinomas after neoadjuvant chemotherapy. Ann Surg Oncol. 2014;21:915–21. (PMID: 10.1245/s10434-013-3410-y2428141924281419)
Francis AM, Sepesi B, Correa AM, Blum MA, Erasmus JJ, Lee JH, et al. The influence of histopathologic tumor viability on long-term survival and recurrence rates following neoadjuvant therapy for esophageal adenocarcinoma. Ann Surg. 2013;258:500–7. (PMID: 10.1097/SLA.0b013e3182a196f42402244224022442)
Becker K, Langer R, Reim D, Novotny A, Meyer Zum Buschenfelde C, Engel J, et al. Significance of histopathological tumor regression after neoadjuvant chemotherapy in gastric adenocarcinomas: a summary of 480 cases. Ann Surg. 2011;253:934–9. (PMID: 10.1097/SLA.0b013e318216f4492149045121490451)
Donohoe CL, O’Farrell NJ, Grant T, King S, Clarke L, Muldoon C, et al. Classification of pathologic response to neoadjuvant therapy in esophageal and junctional cancer: assessment of existing measures and proposal of a novel 3-point standard. Ann Surg. 2013;258:784–92. (PMID: 10.1097/SLA.0b013e3182a665882404545024045450)
Quah HM, Chou JF, Gonen M, Shia J, Schrag D, Saltz LB, et al. Pathologic stage is most prognostic of disease-free survival in locally advanced rectal cancer patients after preoperative chemoradiation. Cancer. 2008;113:57–64. (PMID: 10.1002/cncr.235161844209918442099)
Mace AG, Pai RK, Stocchi L, Kalady MF. American Joint Committee on Cancer and College of American Pathologists regression grade: a new prognostic factor in rectal cancer. Dis Colon Rectum. 2015;58:32–44. (PMID: 10.1097/DCR.00000000000002662548969225489692)
Huebner M, Wolff BG, Smyrk TC, Aakre J, Larson DW. Partial pathologic response and nodal status as most significant prognostic factors for advanced rectal cancer treated with preoperative chemoradiotherapy. World J Surg. 2012;36:675–83. (PMID: 10.1007/s00268-011-1409-82227098022270980)
Kim JY, Park IJ, Hong SM, Lee JL, Yoon YS, Kim CW, et al. Is pathologic near-total regression an appropriate indicator of a good response to preoperative chemoradiotherapy based on oncologic outcome of disease? Medicine (Baltim). 2015;94:e2257. (PMID: 10.1097/MD.0000000000002257)
Swellengrebel HA, Bosch SL, Cats A, Vincent AD, Dewit LG, Verwaal VJ, et al. Tumour regression grading after chemoradiotherapy for locally advanced rectal cancer: a near pathologic complete response does not translate into good clinical outcome. Radiother Oncol. 2014;112:44–51. (PMID: 10.1016/j.radonc.2014.05.0102501800025018000)
Lim SB, Yu CS, Hong YS, Kim TW, Kim JH, Kim JC. Long-term outcomes in patients with locally advanced rectal cancer treated with preoperative chemoradiation followed by curative surgical resection. J Surg Oncol. 2012;106:659–66. (PMID: 10.1002/jso.231812267458122674581)
Nakamura K, Kuwata T, Shimoda T, Mizusawa J, Katayama H, Kushima R, et al. Determination of the optimal cutoff percentage of residual tumors to define the pathological response rate for gastric cancer treated with preoperative therapy (JCOG1004-A). Gastric Cancer. 2015;18:597–604. (PMID: 10.1007/s10120-014-0401-z2496881824968818)
Fareed KR, Ilyas M, Kaye PV, Soomro IN, Lobo DN, Parsons SL, et al. Tumour regression grade (TRG) analyses in patients with resectable gastro-oesophageal adenocarcinomas treated with platinum-based neoadjuvant chemotherapy. Histopathology. 2009;55:399–406. (PMID: 10.1111/j.1365-2559.2009.03404.x1981789019817890)
Fernández-Aceñero MJ, Granja M, Sastre J, García-Paredes B, Estrada L. Prognostic significance of tumor regression in lymph nodes after neoadjuvant therapy for rectal carcinoma. Virchows Arch. 2016;468:425–30. (PMID: 10.1007/s00428-015-1901-x2675467526754675)
Sannier A, Lefèvre JH, Panis Y, Cazals-Hatem D, Bedossa P, Guedj N. Pathological prognostic factors in locally advanced rectal carcinoma after neoadjuvant radiochemotherapy: analysis of 113 cases. Histopathology. 2014;65:623–30. (PMID: 10.1111/his.124322470198024701980)
Philippron A, Bollschweiler E, Kunikata A, Plum P, Schmidt C, Favi F, et al. Prognostic relevance of lymph node regression after neoadjuvant chemoradiation for esophageal cancer. Semin Thorac Cardiovasc Surg. 2016;28:549–58. (PMID: 10.1053/j.semtcvs.2016.04.0032804347528043475)
Kim SH, Chang HJ, Kim DY, Park JW, Baek JY, Kim SY, et al. What is the ideal tumor regression grading system in rectal cancer patients after preoperative chemoradiotherapy? Cancer Res Treat. 2016;48:998–1009. (PMID: 10.4143/crt.2015.2542651180326511803)
Pai RK, Pai RK. Pathologic assessment of gastrointestinal tract and pancreatic carcinoma after neoadjuvant therapy. Mod Pathol. 2017;31:4. (PMID: 10.1038/modpathol.2017.872877657728776577)
Verbeke C, Häberle L, Lenggenhager D, Esposito I. Pathology assessment of pancreatic cancer following neoadjuvant treatment: time to move on. Pancreatology. 2018;18:467–76. (PMID: 10.1016/j.pan.2018.04.010)
Tsekrekos A, Detlefsen S, Riddell R, Conner J, Mastracci L, Sheahan K, et al. Histopathologic tumor regression grading in patients with gastric carcinoma submitted to neoadjuvant treatment: results of a Delphi survey. Hum Pathol. 2019;84:26–34. (PMID: 10.1016/j.humpath.2018.08.0283021762230217622)
Langer R, Reim D, Hofler H, Becker K. Reply to letter: “Tumor regression after neoadjuvant chemotherapy in gastric carcinoma: are there really so few responders?”. Ann Surg. 2014;259:e30. (PMID: 10.1097/SLA.00000000000002802416916724169167)
Moehler M, Delic M, Goepfert K, Aust D, Grabsch HI, Halama N, et al. Immunotherapy in gastrointestinal cancer: recent results, current studies and future perspectives. Eur J Cancer. 2016;59:160–70. (PMID: 10.1016/j.ejca.2016.02.0202703917127039171)
Urabe M, Ushiku T, Seto Y, Fukayama M. Pathologic response of HER2-positive gastric cancer to trastuzumab-based chemotherapy. Am J Surg Pathol. 2016;40:1326–33. (PMID: 10.1097/PAS.00000000000006722725900827259008)
Entry Date(s) :
Date Created: 20191102 Date Completed: 20210125 Latest Revision: 20210125
Update Code :
Czasopismo naukowe
Tumor regression grading is routinely performed on neoadjuvantly treated gastrointestinal cancer resections. Challenges in tumor regression grading include grossing standards, multiple grading systems, and difficulty interpreting therapy-induced changes. We surveyed gastrointestinal pathologists around the world for their practices in handling neoadjuvantly treated gastrointestinal cancer specimens and reporting tumor regression using a 23-question online survey. Topics addressed grossing, histologic work-up, tumor regression grading systems, and degree of difficulty identifying and estimating residual cancer within treatment effect. Two-hundred three responses were received, including 173 participants who completed the entire questionnaire. Fifty percent of the participants were from Europe, 29% from North America, 10% from Australia, and 11% from other continents. Ninety-five percent routinely report a tumor regression grade and 92% have standardized grossing and histologic work-up: 27% always completely embed the entire tumor bed, 54% embed the complete tumor site if not a grossly apparent, large mass. Fifty-nine percent use hematoxylin & eosin alone for assessment; the remaining use additional stains. In North America and Australia, the American Joint Committee on Cancer (AJCC)/College of American Pathologists (CAP)/Ryan system is routinely used for gastroesophageal (71%) and rectal carcinomas (77%). In Europe, the Mandard system is common (36%) for gastroesophageal tumors, followed by AJCC/CAP/Ryan (22%), and Becker (10%); for rectal CA, the Dworak system (30%) is followed by AJCC/CAP/Ryan (24%) and Mandard (14%). This regional differences were significant (p < 0.001 each). Fifty-one percent prefer a four-tiered system. Sixty-six percent think that regressive changes in lymph nodes should be part of a regression grade. Sixty-nine percent consider identifying residual tumor straight-forward, but estimating therapy-induced fibrosis difficult (57%). Free comments raised issues of costs for work-up and clinical relevance. In conclusion, this multinational survey provides a comprehensive overview of grossing and histologic work-up with regards to tumor regression grading in gastrointestinal cancers with partly significant regional differences particularly between North America and Europe.

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