Gut Liver. 2022;16(1):129-137.

Four-Tier Pathologic Tumor Regression Grading System Predicts the Clinical Outcome in Patients Who Undergo Surgical Resection for Locally Advanced Pancreatic Cancer after Neoadjuvant Chemotherapy.

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제1저자 안수민 · 교신저자 황진혁

PMID 33875622 PMC8761920 DOI 10.5009/gnl20312 IF 4.1 소화기내과

소속 (5)

Department of Pathology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.

Abstract

BACKGROUND/AIMS Neoadjuvant chemotherapy is increasingly utilized in patients with borderline or locally advanced pancreatic cancer (LAPC). However, the pathologic evaluation of tumor regression is not routinely performed or well established. We aimed to evaluate the prognostic value of three tumor regression grading systems frequently used in LAPC and to determine the correlation between pathologic and clinical response.

METHODS We included a total of 38 patients with LAPC who were treated with neoadjuvant chemotherapy and subsequent resection. Pathologic tumor regression was graded based on the College of American Pathologists (CAP), Evans, and MD Anderson grading systems.

RESULTS One out of 38 patients (2.6%) achieved a pathologic complete response. Unlike other grading systems (Evans, p=0.063; MD Anderson, p=0.110), the CAP grading system was a significant prognostic factor for overall survival (p=0.043). Pathologic N stage (p=0.023), margin status (p=0.044), and radiologic response (p=0.016) correlated with overall survival. In the multivariate analysis, CAP 3 was an independent predictor of shorter overall survival (p=0.026). The CAP grading system correlated with the radiologic response (p=0.007) but not the carbohydrate antigen 19-9 level (p=0.333).

CONCLUSIONS The four-tier CAP pathologic tumor regression grading system predicted the clinical outcome in LAPC patients who underwent resection after neoadjuvant chemotherapy. Therefore, a more comprehensive pathologic evaluation is warranted in these patients.

Keywords

Neoadjuvant therapyPancreatic neoplasmsTumor regression grading

Figures

**Fig. 1** Representative images of College of American Pathologists (CAP) tumor regression grading system in pancreatic cancer. (A) CAP score 0: no viable cancer cells (complete response) (H&E, ×10). (B) CAP score 1: single cells or rare groups of cancer cells (near complete response) (arrows: cancer cells, H&E, ×10). (C) CAP score 2: residual cancer with evident tumor regression but more than single cells or rare groups of cancer cells (partial response) (H&E, ×10). (D) CAP score 3: extensive residual cancer with no evidence of tumor regression (poor or no response) (H&E, ×10).

**Fig. 2** Correlations of nodal status and margin status with overall survival. (A) Kaplan-Meier curves indicate that the pathologic nodal status is a significant prognostic factor predicting overall survival. (B) Kaplan-Meier curves indicate that conventional resection margin status is a significant prognostic factor predicting overall survival (R0 vs R1).

**Fig. 3** Kaplan-Meier overall survival analysis according to three pathologic tumor regression grading systems. (A) College of American Pathologists (CAP) grading system significantly predicted overall survival. No such significance was observed for (B) the Evans grading system or (C) the MD Anderson grading system.

**Fig. 4** Correlation between radiologic tumor size measured on preoperative computed tomography (CT) and pathologic tumor size. There was a correlation between radiologic and pathologic tumor sizes (Spearman correlation value=0.551).

그림 출처: PubMed Central 공개 논문 (PMC8761920)

Conflict of interest statement

CONFLICTS OF INTEREST . No potential conflict of interest relevant to this article was reported.

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