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International Journal of Surgical Oncology
Volume 2013, Article ID 572149, 8 pages
http://dx.doi.org/10.1155/2013/572149
Clinical Study

Tumor Regression Grades: Can They Influence Rectal Cancer Therapy Decision Tree?

1Digestive Surgery Service, Department of Surgery, Hospital de Santo António, Largo Professor Abel Salazar, 4099-003 Porto, Portugal
2Department of Community Health, Instituto de Ciências Biomédicas Abel Salazar, Rua Jorge Viterbo Ferreira No. 228, 4050-313 Porto, Portugal
3Pathological Anatomy Service, Department of Pathology, Hospital de Santo António, Largo Professor Abel Salazar, 4099-003 Porto, Portugal
4Department of Pathology and Molecular Immunology, Instituto de Ciências Biomédicas Abel Salazar, Rua Jorge Viterbo Ferreira No. 228, 4050-313 Porto, Portugal

Received 30 April 2013; Revised 17 August 2013; Accepted 17 August 2013

Academic Editor: Frank A. Frizelle

Copyright © 2013 Marisa D. Santos et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background. Evaluating impact of tumor regression grade in prognosis of patients with locally advanced rectal cancer (LARC). Materials and Methods. We identified from our colorectal cancer database 168 patients with LARC who received neoadjuvant therapy followed by complete mesorectum excision surgery between 2003 and 2011: 157 received 5-FU-based chemoradiation (CRT) and 11 short course RT. We excluded 29 patients, the remaining 139 were reassessed for disease recurrence and survival; the slides of surgical specimens were reviewed and classified according to Mandard tumor regression grades (TRG). We compared patients with good response (Mandard TRG1 or TRG2) versus patients with bad response (Mandard TRG3, TRG4, or TRG5). Outcomes evaluated were 5-year overall survival (OS), disease-free survival (DFS), local, distant and mixed recurrence. Results. Mean age was 64.2 years, and median followup was 56 months. No statistically significant survival difference was found when comparing patients with Mandard TRG1 versus Mandard TRG2 ( ). Mandard good responders (TRG1 + 2) have significantly better OS and DFS than Mandard bad responders (TRG3 + 4 + 5) (OS ; DFS ). Conclusions. Mandard good responders had a favorable prognosis. Tumor response (TRG) to neoadjuvant chemoradiation should be taken into account when defining the optimal adjuvant chemotherapy regimen for patients with LARC.