Annals of Coloproctology

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Original Article

An investigation into tumor regression grade as a parameter for locally advanced rectal cancer and 5-year overall survival rate: Supparerk Laohawiriyakamol, Wongsakorn Chaochankit, Worawit Wanichsuwan, Kanet Kanjanapradit, Teeranan Laohawiriyakamol; Ann Coloproctol. 2023;39(1):59-70. Published online March 18, 2022; DOI: https://doi.org/10.3393/ac.2021.01011.0144

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Purpose
The standard treatment for locally advanced rectal cancer (LARC) is neoadjuvant chemoradiation (nCRT) followed by surgery. Several parameters are associated with patient survival in LARC. One of these parameters is tumor regression grade (TRG); however, the significance of TRG remains controversial. In this study, we aimed to examine the correlations of TRG with 5-year overall (OS) and relapse-free survival (RFS) and identify other factors that influence the survival rates in LARC after nCRT followed by surgery.
Methods
This retrospective study included 104 patients diagnosed with LARC who underwent nCRT followed by surgery at Songklanagarind Hospital from January 2010 to December 2015. All patients received fluoropyrimidine-based chemotherapy at a total dose of 45.0 to 50.4 Gy in 25 daily fractions. Tumor response was evaluated using the 5-tier Mandard TRG classification. TRG was categorized into good (TRG 1–2) and poor (TRG 3–5) responses.
Results
TRG (classified by either the 5-tier classification system or the 2-group classification system) was not correlated with 5-year OS or RFS. The 5-year OS rates were 80.0%, 54.5%, 80.8%, and 67.4% in patients with TRG 1, 2, 3, and 4, respectively (P=0.22). Poorly differentiated rectal cancer and systemic metastasis were associated with poor 5-year OS. Intraoperative tumor perforation, poor differentiation, and perineural invasion were correlated with inferior 5-year RFS.
Conclusion
TRG was probably not associated with either 5-year OS or RFS; however, poor differentiation and systemic metastasis were strongly associated with poor 5-year OS.

Citations

Citations to this article as recorded by

Impact of Hemoglobin Levels on Treatment Response and Survival in Locally Advanced Rectal Cancer: A Retrospective Cohort Study
Seyed Kazem Mirinezhad, Mohammad Mohammadzadeh, Amir Ghasemi Jangjoo
Journal of Research in Clinical Medicine.2026; 14: 34681. CrossRef
Is Mandard tumor regression grade scoring sufficient for locally advanced rectal cancer?
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Medical Science and Discovery.2025; 12(1): 1. CrossRef
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BMC Cancer.2025;[Epub] CrossRef
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Performance reporting design in artificial intelligence studies using image-based TNM staging and prognostic parameters in rectal cancer: a systematic review
Minsung Kim, Taeyong Park, Bo Young Oh, Min Jeong Kim, Bum-Joo Cho, Il Tae Son
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Risk-factors for locally advanced rectal cancer relapse after neoadjuvant chemoradiotherapy: A single center experience
Dragana Stupar, Saša Jungić, Zdenka Gojković, Jelena Berendika, Živojin Janičić
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