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Prognostic value of Dworak grade of regression (GR) in patients with rectal carcinoma treated with preoperative radiochemotherapy

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Abstract

Background and aim

Preoperative radiochemotherapy improves local control in locally advanced rectal cancer; however, its role in prolonging survival is still controversial. In order to better define the subset in patients who might benefit from this multimodal treatment, we have evaluated the correlation between grade of regression (GR) to preoperative treatment and disease-free survival (DFS).

Methods

We reviewed retrospectively the surgical specimens of 106 patients with locally advanced T3/T4 N0/ M0 rectal cancer. All patients were treated preoperatively with radiotherapy and 5-fluorouracil-based regimen chemotherapy. We evaluated ypTNM stage, and tumor regression was graded using the Dworak system that varies from GR 0 (absence of regression) to GR 4 (complete regression).

Results

GR was as follows: GR 4, 16 patients (15%); GR 3, 25 patients (23.6%), GR 2, 30 patients (28.4%), GR 1, 32 patients (30.2%) and GR 0, 3 patients (2.8%). A significant correlation was found between GR and DFS. Three-year DFS was 100, 85, 82, 66 and 33% in GR 4, 3, 2, 1 and 0, respectively (p=0.01). DFS was significantly lower in patients with advanced stages at diagnosis and in patients without down-staging. Moreover, in postoperative stage II and III cases, GR 3 correlated with a better DFS than GR 2–0 (p=0.2 and p=0.4, respectively).

Conclusions

The GR was a significant prognostic factor in locally advanced rectal carcinoma treated with preoperative chemoradiotherapy. The pathological stage and down-staging also have prognostic value. The use of a standardized system to evaluate GR in rectal cancer can allow for comparisons between different institutions and can identify patients at worse prognosis to be treated with adjuvant therapy.

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Acknowledgements

The authors thank Giuseppe Colucci, Sergio Bicocchi, Gino Gibertini, Antonio Manenti, Gianluigi Melotti, Gianni Natalini, Massimo Saviano and Ernesto Tamborrino on behalf of the Surgery Division of Modena and province and Luca Fabbiani for production of the microphotograph.

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Authors and Affiliations

  1. Department of Pathology, University of Modena and Reggio Emilia, Modena, Italy

    Lorena Losi

  2. Department of Oncology and Haematology, University of Modena and Reggio Emilia, Modena, Italy

    Gabriele Luppi, Francesco Iachetta, Federica Bertolini, Roberto D’Amico, Gordana Jovic & Pier Franco Conte

  3. III Division of Surgery, Policlinico Hospital, Modena, Italy

    Margherita Gavioli

  4. Department of Radiotherapy, University of Modena and Reggio Emilia, Modena, Italy

    Filippo Bertoni & Anna Maria Falchi

  5. Anatomia Patologica, Via del Pozzo 71, 41100, Modena, Italy

    Lorena Losi

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  1. Lorena Losi
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  2. Gabriele Luppi
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Correspondence to Lorena Losi.

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Losi, L., Luppi, G., Gavioli, M. et al. Prognostic value of Dworak grade of regression (GR) in patients with rectal carcinoma treated with preoperative radiochemotherapy. Int J Colorectal Dis 21, 645–651 (2006). https://doi.org/10.1007/s00384-005-0061-x

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  • DOI: https://doi.org/10.1007/s00384-005-0061-x

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