Park Young Joo, Oh Byung Ryul, Lim Sang Woo, Huh Jung Wook, Joo Jae Kyun, Kim Young Jin, Kim Hyeong Rok
Department of Surgery, Chonnam National University Medical School, Gwangju, Korea.
J Korean Soc Coloproctol. 2010 Aug;26(4):279-86. doi: 10.3393/jksc.2010.26.4.279. Epub 2010 Aug 31.
Neoadjuvant chemoradiotherapy applied to the locally advanced rectal cancer reduces local recurrence and improves survival. We assessed tumor regression grade (TRG) and its influence on survival in rectal cancer patients treated with chemoradiotherapy followed by surgical resection.
We studied 108 patients that were seen at our hospital between August 2004 and December 2008. Patients received preoperative chemoradiotherapy consisting of 5-fluorouracil and leucovorin by continous infusion during the first and fifth week, delivered with concurrent pelvic radiation of 50.4 Gy, followed by radical surgery at 6-8 weeks. The TRG was determined by the amount of fibrosis in the tumor embedding area and was divided into 5 grades based on the relative amount of fibrosis. We analyzed all preoperative clinicopathologic factors, postoperative pathologic stages, TRG and prognosis, retrospectively.
Downstaging of rectal cancer through neoadjuvant chemoradiotherapy occurred in 64 (59%) patients. The numbers of total regressions (TRG4), good regressions (TRG3), moderate regressions (TRG2), minor regressions (TRG1), and no regression (TRG0) were 19 (18%), 65 (60%), 17 (16%), 6 (5%), and 1 (1%) respectively. The TRG was inversely correlated with perineural invasion and lymphovascular invasion (P = 0.008, P = 0.032). The local recurrence rate declined as the tumor regression grade increased (P = 0.032). The 19 patients with TRG4 had a better three-year disease free survival than the 89 patients with TRG0-3 (P = 0.034). The 16 patients with pathologic complete remission (pCR) had a better three-year disease free survival than the 92 patients with non-pCR (P = 0.025).
Higher TRG after preoperative chemoradiotherapy for rectal cancer closely correlates with better survival and low local recurrence. The TRG is considered to be a significant prognostic factor.
新辅助放化疗应用于局部晚期直肠癌可降低局部复发率并提高生存率。我们评估了肿瘤退缩分级（TRG）及其对接受放化疗后手术切除的直肠癌患者生存率的影响。
我们研究了2004年8月至2008年12月期间在我院就诊的108例患者。患者接受术前放化疗，在第一周和第五周通过持续输注5-氟尿嘧啶和亚叶酸钙，并同时进行盆腔50.4 Gy的放射治疗，随后在6-8周进行根治性手术。TRG由肿瘤包埋区域的纤维化程度决定，并根据纤维化的相对量分为5级。我们回顾性分析了所有术前临床病理因素、术后病理分期、TRG和预后。
64例（59%）患者通过新辅助放化疗实现了直肠癌降期。完全退缩（TRG4）、良好退缩（TRG3）、中度退缩（TRG2）、轻度退缩（TRG1）和无退缩（TRG0）的患者数量分别为19例（18%）、65例（60%）、17例（16%）、6例（5%）和1例（1%）。TRG与神经周围侵犯和淋巴管侵犯呈负相关（P = 0.008，P = 0.032）。局部复发率随着肿瘤退缩分级的增加而下降（P = 0.032）。19例TRG4患者的三年无病生存率优于89例TRG0-3患者（P = 0.034）。16例病理完全缓解（pCR）患者的三年无病生存率优于92例非pCR患者（P = 0.025）。
直肠癌术前放化疗后较高的TRG与更好的生存率和低局部复发密切相关。TRG被认为是一个重要的预后因素。
