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Tumor Regression Grade Predicts Survival in Locally Advanced Gastric Adenocarcinoma Patients with Lymph Node Metastasis.

ABSTRACT: Background:Tumor regression grade (TRG) is widely used in gastrointestinal carcinoma to evaluate pathological responses to neoadjuvant chemotherapy (NCT), but whether it is an independent prognostic factor is still controversial. The aim of this study is to investigate the value of TRG in locally advanced gastric adenocarcinoma patients who underwent NCT and curative resection. Methods:Pathological regression was reevaluated according to the Mandard TRG. Survival curves were obtained by the Kaplan-Meier method, and differences in overall survival (OS) and disease-free survival (DFS) were compared using the log-rank test. Univariate and multivariate analyses for survival were based on the Cox proportional hazards method. Results:In total, 290 patients were identified in our electronic database. In univariable analysis, TRG was associated with OS (HR = 3.822, P ? 0.001) and DFS (HR = 3.374, P ? 0.001). However, in multivariable analysis, TRG was not an independent factor for OS (P = 0.231) or DFS (P = 0.191). In the stratified analysis, TRG retrieved prognostic significance in patients with the metastasis of lymph node (HR = 2.034, P = 0.035 for OS; HR = 2.220, P = 0.016 for DFS), while not in patients with negative lymph node (P = 0.296 for OS; P = 0.172 for DFS). Conclusions:TRG was not an independent predictor for survival, but the system regained its predicting significance in patients with lymph node metastasis.

SUBMITTER: Tong Y

PROVIDER: S-EPMC7383330 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Tumor Regression Grade Predicts Survival in Locally Advanced Gastric Adenocarcinoma Patients with Lymph Node Metastasis.

Tong Yilin Y Zhu Yanmei Y Zhao Yan Y Shan Zexing Z Zhang Jianjun J Liu Dong D

Gastroenterology research and practice 20200718

<h4>Background</h4>Tumor regression grade (TRG) is widely used in gastrointestinal carcinoma to evaluate pathological responses to neoadjuvant chemotherapy (NCT), but whether it is an independent prognostic factor is still controversial. The aim of this study is to investigate the value of TRG in locally advanced gastric adenocarcinoma patients who underwent NCT and curative resection.<h4>Methods</h4>Pathological regression was reevaluated according to the Mandard TRG. Survival curves were obtai ...[more]

PMID: 32733550

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Project description:Objective: To develop and evaluate a diffusion-weighted imaging (DWI)-based radiomic nomogram for lymph node metastasis (LNM) prediction in advanced gastric cancer (AGC) patients. Overall Study: This retrospective study was conducted with 146 consecutively included pathologically confirmed AGC patients from two centers. All patients underwent preoperative 3.0 T magnetic resonance imaging (MRI) examination. The dataset was allocated to a training cohort (n = 71) and an internal validation cohort (n = 47) from one center along with an external validation cohort (n = 28) from another. A summary of 1,305 radiomic features were extracted per patient. The least absolute shrinkage and selection operator (LASSO) logistic regression and learning vector quantization (LVQ) methods with cross-validations were adopted to select significant features in a radiomic signature. Combining the radiomic signature and independent clinical factors, a radiomic nomogram was established. The MRI-reported N staging and the MRI-derived model were built for comparison. Model performance was evaluated considering receiver operating characteristic (ROC) analysis, calibration curves, and decision curve analysis (DCA). Results: A two-feature radiomic signature was found significantly associated with LNM (p < 0.01, training and internal validation cohorts). A radiomic nomogram was established by incorporating the clinical minimum apparent diffusion coefficient (ADC) and MRI-reported N staging. The radiomic nomogram showed a favorable classification ability with an area under ROC curve of 0.850 [95% confidence interval (CI), 0.758-0.942] in the training cohort, which was then confirmed with an AUC of 0.857 (95% CI, 0.714-1.000) in internal validation cohort and 0.878 (95% CI, 0.696-1.000) in external validation cohort. Meanwhile, the specificity, sensitivity, and accuracy were 0.846, 0.853, and 0.851 in internal validation cohort, and 0.714, 0.952, and 0.893 in external validation cohort, compensating for the MRI-reported N staging and MRI-derived model. DCA demonstrated good clinical use of radiomic nomogram. Conclusions: This study put forward a DWI-based radiomic nomogram incorporating the radiomic signature, minimum ADC, and MRI-reported N staging for individualized preoperative detection of LNM in patients with AGC.

Dataset Information

Tumor Regression Grade Predicts Survival in Locally Advanced Gastric Adenocarcinoma Patients with Lymph Node Metastasis.

Publications

Tumor Regression Grade Predicts Survival in Locally Advanced Gastric Adenocarcinoma Patients with Lymph Node Metastasis.

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