Institute of Pathology, Technische Universität München, München, Germany.
Mod Pathol. 2009 Dec;22(12):1555-63. doi: 10.1038/modpathol.2009.123. Epub 2009 Oct 2.
We evaluated histomorphological findings in 92 surgical resection specimens of locally advanced esophageal adenocarcinomas after neoadjuvant cisplatin-based chemotherapy. Tumor response to neoadjuvant chemotherapy was determined using a system encompassing three tumor regression grades based on the estimation of the percentage of residual tumor tissue of the primary tumor site in relation to the macroscopically identifiable previous tumor bed. The significance of this system was validated by correlation of the tumor regression grades with the corresponding clinicopathological characteristics and patient survival. Seven patients (7%) had complete tumor regression (grade tumor regression grade 1), 48 patients (52%) had subtotal or partial tumor regression (tumor regression grade 2: 1-50% residual tumor), and 37 patients (40%) had minimal or no regression (tumor regression grade 3: >50% residual tumor). Tumor regression was significantly associated with posttreatment complete tumor resection status (UICC R0 status; P=0.016), tumor category (UICC pT category; P<0.001), and with the absence of either lymph node metastases (P=0.001) or lymphatic invasion (P<0.001). Survival analysis showed a significant prognostic relevance of the applied regression system in univariate (P<0.001) and multivariate analyses as a single independent factor (P=0.024). We conclude that the effect of preoperative chemotherapy in esophageal adenocarcinomas can be assessed by the determination of histological tumor regression, providing highly valuable prognostic information, which may even exceed the prognostic impact of the current TNM classification of these tumors. Therefore, we strongly recommend the implementation of a standardized tumor regression grading system in pathological reports of esophageal adenocarcinomas treated by neoadjuvant chemotherapy.
我们评估了 92 例局部晚期食管腺癌新辅助顺铂为基础的化疗后手术切除标本的组织形态学发现。使用基于肿瘤组织残留量相对于大体可识别的先前肿瘤床的百分比来估计的包含三个肿瘤消退等级的系统来确定新辅助化疗的肿瘤反应。通过将肿瘤消退等级与相应的临床病理特征和患者生存相关联，验证了该系统的意义。7 例（7%）患者肿瘤完全消退（肿瘤消退等级 1），48 例（52%）患者肿瘤部分或完全消退（肿瘤消退等级 2：1-50%残留肿瘤），37 例（40%）患者肿瘤消退程度最小或无（肿瘤消退等级 3：>50%残留肿瘤）。肿瘤消退与治疗后完全肿瘤切除状态（UICC R0 状态；P=0.016）、肿瘤分类（UICC pT 分类；P<0.001）以及无淋巴结转移（P=0.001）或淋巴管浸润（P<0.001）显著相关。生存分析显示，应用的回归系统在单因素（P<0.001）和多因素分析中作为单一独立因素具有显著的预后相关性（P=0.024）。我们得出结论，通过确定组织学肿瘤消退，可以评估术前化疗对食管腺癌的作用，提供非常有价值的预后信息，甚至可能超过这些肿瘤当前 TNM 分类的预后影响。因此，我们强烈建议在新辅助化疗治疗的食管腺癌病理报告中实施标准化的肿瘤消退分级系统。
