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Pathological grading of regression: an International Study Group perspective
  1. Runjan Chetty1,
  2. P Gill1,
  3. Adrian C Bateman2,
  4. David K Driman3,
  5. Dhirendra Govender4,
  6. Andrew R Bateman5,
  7. Y J Chua6,
  8. Godman Greywoode1,
  9. Christine Hemmings7,
  10. I Imat8,
  11. Eleanor Jaynes2,
  12. Cheok Soon Lee9,
  13. Michael Locketz4,
  14. Corwyn Rowsell10,
  15. Anne Rullier11,
  16. Stefano Serra12,
  17. Eva Szentgyorgyi12,
  18. Rajkumar Vajpeyi12,
  19. David Delaney1,
  20. Lai Mun Wang1
  1. 1Department of Cellular Pathology/Biomedical Research Centre/Nuffield Department of Clinical Laboratory Sciences, Oxford University Hospitals and University of Oxford, Oxford, UK
  2. 2Department of Cellular Pathology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
  3. 3Department of Pathology, London Health Sciences Centre/Western University of Ontario, London, Ontario, Canada
  4. 4Division of Anatomical Pathology, University of Cape Town/NHLS-Groote Schuur Hospital, Cape Town, South Africa
  5. 5Cancer Sciences, University of Southampton, Southampton, UK
  6. 6Medical Oncology Unit, The Canberra Hospital and Australian National University Medical School, Canberra, Australian Capital Territory, Australia
  7. 7Department of Anatomical Pathology, The Canberra Hospital and School of Surgery, University of Western Australia, Canberra, Australian Capital Territory, Australia
  8. 8Department of Pathology, Hospital de Navarra, Pamplona, Spain
  9. 9Department of Anatomical Pathology, Discipline of Pathology, School of Medicine, University of Western Sydney, Liverpool & Royal Prince Alfred Hospital, Sydney, Australia
  10. 10Department of Pathology, Sunnybrook Health Science Center/University of Toronto, Toronto, Canada
  11. 11Department of Pathology, CHU Bordeaux, Bordeaux, France
  12. 12Department of Pathology, University Health Network/University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Professor Runjan Chetty, Department of Cellular Pathology, Level 1, Academic Centre, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK; runjan.chetty{at}

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In this issue of the Journal of Clinical Pathology, MacGregor, Maughan and Sharma1 discuss the value and utility of pathological grading of regression from an oncologist's point of view.

Neoadjuvant chemoradiotherapy is now a well-accepted treatment for locally advanced rectal cancer (cT3/T4 or lymph node-positive rectal cancers). However, neoadjuvant therapy affects the histopathological reporting of resected specimens by virtue of the host response to treatment, which occurs in the majority of patients. Pathological complete responses ranging from 9% to 29% have been reported,2 ,3 but the clinical significance of ‘incomplete’ regression and, more importantly, its role in determining postoperative treatment, is not clear. Pathological complete response has been associated with good patient outcomes.4–7 However, tumour regression grade (although having prognostic value for survival and recurrence by univariate analyses) has not been established to be an independent prognostic value that is superior to ypTNM in predicting clinical outcome.6 ,7–13 On the contrary, Min et al11 demonstrated that regression grading is a good prognostic factor in patients with lymph node negative locally advanced rectal cancer. Therefore, regression grading may be a useful parameter for monitoring patient response and also as a potential prognostic factor.

Several grading systems have been proposed and used, the most popular one being the Mandard and Dworak systems.14 ,15. We, an ‘International …

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  • Competing interests None.

  • Provenance and peer review Commissioned; internally peer reviewed.