In locally advanced cervical cancer (LACC), definitive chemo-radiotherapy is the standard treatment, but chemo-radiotherapy followed by surgery could be an alternative choice in selected patients. We enrolled 244 patients affected by LACC and treated with CT-RT followed by surgery in order to assess the prognostic role of the histological response using the Mandard scoring system. Results: A complete pathological response (TRG 0) was observed in 118 patients (48.4%), rare residual cancer cells (TRG2) were found in 49 cases (20.1%), increased number of cancer cells but fibrosis still predominating (TRG3) in 35 cases (14.3%), and 42 (17.2%) were classified as non-responders (TRG4–5). TRG was significantly associated with both OS (p < 0.001) and PFS (p < 0.001). The survival curves highlighted two main prognostic groups: TRG1-TRG2 and TRG3-TRG4–5. Main responders (TRG1–2) showed a 92% 5-year overall survival (5y-OS) and a 75% 5-year disease free survival (5y-DFS). Minor or no responders showed a 48% 5y-OS and a 39% 5y-DFS. The two-tiered TRG was independently associated with both DFS and OS in Cox regression analysis. Conclusion. We showed that Mandard TRG is an independent prognostic factor in post-CT/RT LACC, with potential benefits in defining post-treatment adjuvant therapy.
Scaglione, G., Arciuolo, D., Travaglino, A., Santoro, A., Angelico, G., Spadola, S., Inzani, F., D'Alessandris, N., Raffone, A., Fulgione, C., Padial Urtueta, B., Sfregola, S., Valente, M., Addante, F., D'Amati, A., Cianfrini, F., Piermattei, A., Pedone Anchora, L., Scambia, G., Ferrandina, M. G., Zannoni, G. F., Prognostic Value of Mandard’s Tumor Regression Grade (TRG) in Post Chemo-Radiotherapy Cervical Cancer, <<DIAGNOSTICS>>, 2023; 13 (20): 1-13. [doi:10.3390/diagnostics13203228] [https://hdl.handle.net/10807/283486]
Prognostic Value of Mandard’s Tumor Regression Grade (TRG) in Post Chemo-Radiotherapy Cervical Cancer
Arciuolo, Damiano;Santoro, Angela;Inzani, Frediano;D'Alessandris, Nicoletta;Cianfrini, Federica;Piermattei, Angelo;Pedone Anchora, Luigi;Scambia, Giovanni;Ferrandina, Maria Gabriella;Zannoni, Gian Franco
2023
Abstract
In locally advanced cervical cancer (LACC), definitive chemo-radiotherapy is the standard treatment, but chemo-radiotherapy followed by surgery could be an alternative choice in selected patients. We enrolled 244 patients affected by LACC and treated with CT-RT followed by surgery in order to assess the prognostic role of the histological response using the Mandard scoring system. Results: A complete pathological response (TRG 0) was observed in 118 patients (48.4%), rare residual cancer cells (TRG2) were found in 49 cases (20.1%), increased number of cancer cells but fibrosis still predominating (TRG3) in 35 cases (14.3%), and 42 (17.2%) were classified as non-responders (TRG4–5). TRG was significantly associated with both OS (p < 0.001) and PFS (p < 0.001). The survival curves highlighted two main prognostic groups: TRG1-TRG2 and TRG3-TRG4–5. Main responders (TRG1–2) showed a 92% 5-year overall survival (5y-OS) and a 75% 5-year disease free survival (5y-DFS). Minor or no responders showed a 48% 5y-OS and a 39% 5y-DFS. The two-tiered TRG was independently associated with both DFS and OS in Cox regression analysis. Conclusion. We showed that Mandard TRG is an independent prognostic factor in post-CT/RT LACC, with potential benefits in defining post-treatment adjuvant therapy.
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