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Prognostic value of tumor shrinkage versus fragmentation following radiochemotherapy and surgery for rectal cancer

Monirath Hav (UGent) , Louis Libbrecht (UGent) , Karen Geboes (UGent) , Liesbeth Ferdinande (UGent) , Tom Boterberg (UGent) , Wim Ceelen (UGent) , Piet Pattyn (UGent) and Claude Cuvelier (UGent)
(2015) VIRCHOWS ARCHIV. 466(5). p.517-523
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Abstract
Most patients with rectal cancer receive neoadjuvant radiochemotherapy (RCT), causing a variable decrease in tumor mass. We evaluated the prognostic impact of pathologic parameters reflecting tumor response to RCT, either directly or indirectly. Seventy-six rectal cancer patients receiving neoadjuvant RCT between 2006 and 2009 were included. We studied the association between disease-free survival (DFS) and the "classical" clinicopathologic features as well as tumor deposits, circumferential resection margin (CRM), Dworak regression grade, and tumor and nodal downstaging. Patients with tumor downstaging had a longer DFS (p = 0.05), indicating a more favorable prognosis when regression was accompanied by a decrease in tumor infiltrative depth, referred to as tumor shrinkage. Moreover, tumor downstaging was significantly associated with larger CRM and nodal downstaging (p = 0.02), suggesting that shrinkage of the primary tumor was associated with a decreased nodal tumor load. Higher Dworak grade did not correlate with tumor downstaging, nor with higher CRM or prolonged DFS. This implies that tumor mass decrease was sometimes due to fragmentation rather than shrinkage of the primary tumor. Lastly, the presence of tumor deposits was clearly associated with reduced DFS (p = 0.01). Assessment of tumor shrinkage after RCT via tumor downstaging and CRM is a good way of predicting DFS in rectal cancer, and shrinkage of the primary tumor is associated with a decreased nodal tumor load. Assessing regression based on the amount of tumor in relation to stromal fibrosis does not accurately discern tumor fragmentation from tumor shrinkage, which is most likely the reason why Dworak grade had less prognostic relevance.
Keywords
Fragmentation, Tumor response, Shrinkage, Chemoradiation, Rectal cancer, Neoadjuvant, PREOPERATIVE CHEMORADIOTHERAPY, NEOADJUVANT CHEMORADIOTHERAPY, PATHOLOGICAL ASSESSMENT, CIRCUMFERENTIAL MARGIN, CLINICAL-SIGNIFICANCE, COLORECTAL-CANCER, REGRESSION GRADE, STAGING SYSTEM, CARCINOMA, TOTAL MESORECTAL EXCISION

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Citation

Please use this url to cite or link to this publication:

MLA
Hav, Monirath et al. “Prognostic Value of Tumor Shrinkage Versus Fragmentation Following Radiochemotherapy and Surgery for Rectal Cancer.” VIRCHOWS ARCHIV 466.5 (2015): 517–523. Print.
APA
Hav, M., Libbrecht, L., Geboes, K., Ferdinande, L., Boterberg, T., Ceelen, W., Pattyn, P., et al. (2015). Prognostic value of tumor shrinkage versus fragmentation following radiochemotherapy and surgery for rectal cancer. VIRCHOWS ARCHIV, 466(5), 517–523.
Chicago author-date
Hav, Monirath, Louis Libbrecht, Karen Geboes, Liesbeth Ferdinande, Tom Boterberg, Wim Ceelen, Piet Pattyn, and Claude Cuvelier. 2015. “Prognostic Value of Tumor Shrinkage Versus Fragmentation Following Radiochemotherapy and Surgery for Rectal Cancer.” Virchows Archiv 466 (5): 517–523.
Chicago author-date (all authors)
Hav, Monirath, Louis Libbrecht, Karen Geboes, Liesbeth Ferdinande, Tom Boterberg, Wim Ceelen, Piet Pattyn, and Claude Cuvelier. 2015. “Prognostic Value of Tumor Shrinkage Versus Fragmentation Following Radiochemotherapy and Surgery for Rectal Cancer.” Virchows Archiv 466 (5): 517–523.
Vancouver
1.
Hav M, Libbrecht L, Geboes K, Ferdinande L, Boterberg T, Ceelen W, et al. Prognostic value of tumor shrinkage versus fragmentation following radiochemotherapy and surgery for rectal cancer. VIRCHOWS ARCHIV. 2015;466(5):517–23.
IEEE
[1]
M. Hav et al., “Prognostic value of tumor shrinkage versus fragmentation following radiochemotherapy and surgery for rectal cancer,” VIRCHOWS ARCHIV, vol. 466, no. 5, pp. 517–523, 2015.
@article{5933980,
  abstract     = {Most patients with rectal cancer receive neoadjuvant radiochemotherapy (RCT), causing a variable decrease in tumor mass. We evaluated the prognostic impact of pathologic parameters reflecting tumor response to RCT, either directly or indirectly. Seventy-six rectal cancer patients receiving neoadjuvant RCT between 2006 and 2009 were included. We studied the association between disease-free survival (DFS) and the "classical" clinicopathologic features as well as tumor deposits, circumferential resection margin (CRM), Dworak regression grade, and tumor and nodal downstaging. Patients with tumor downstaging had a longer DFS (p = 0.05), indicating a more favorable prognosis when regression was accompanied by a decrease in tumor infiltrative depth, referred to as tumor shrinkage. Moreover, tumor downstaging was significantly associated with larger CRM and nodal downstaging (p = 0.02), suggesting that shrinkage of the primary tumor was associated with a decreased nodal tumor load. Higher Dworak grade did not correlate with tumor downstaging, nor with higher CRM or prolonged DFS. This implies that tumor mass decrease was sometimes due to fragmentation rather than shrinkage of the primary tumor. Lastly, the presence of tumor deposits was clearly associated with reduced DFS (p = 0.01). Assessment of tumor shrinkage after RCT via tumor downstaging and CRM is a good way of predicting DFS in rectal cancer, and shrinkage of the primary tumor is associated with a decreased nodal tumor load. Assessing regression based on the amount of tumor in relation to stromal fibrosis does not accurately discern tumor fragmentation from tumor shrinkage, which is most likely the reason why Dworak grade had less prognostic relevance.},
  author       = {Hav, Monirath and Libbrecht, Louis and Geboes, Karen and Ferdinande, Liesbeth and Boterberg, Tom and Ceelen, Wim and Pattyn, Piet and Cuvelier, Claude},
  issn         = {0945-6317},
  journal      = {VIRCHOWS ARCHIV},
  keywords     = {Fragmentation,Tumor response,Shrinkage,Chemoradiation,Rectal cancer,Neoadjuvant,PREOPERATIVE CHEMORADIOTHERAPY,NEOADJUVANT CHEMORADIOTHERAPY,PATHOLOGICAL ASSESSMENT,CIRCUMFERENTIAL MARGIN,CLINICAL-SIGNIFICANCE,COLORECTAL-CANCER,REGRESSION GRADE,STAGING SYSTEM,CARCINOMA,TOTAL MESORECTAL EXCISION},
  language     = {eng},
  number       = {5},
  pages        = {517--523},
  title        = {Prognostic value of tumor shrinkage versus fragmentation following radiochemotherapy and surgery for rectal cancer},
  url          = {http://dx.doi.org/10.1007/s00428-015-1723-x},
  volume       = {466},
  year         = {2015},
}

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