Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA.
Cancer. 2012 Jun 15;118(12):3182-90. doi: 10.1002/cncr.26651. Epub 2011 Oct 25.
Several grading schemes for the extent of residual tumor in posttreatment pancreaticoduodenectomy (PD) specimens have been proposed. However, the prognostic significance of these grading schemes is unknown.
Histopathologic slides of 223 cases who received neoadjuvant chemoradiation and PD were reviewed. The extent of residual tumor was graded using both the College of American Pathologists (CAP) and the Evans grading systems. The grading results were correlated with clinicopathological parameters and survival.
Among the 223 patients, 6 patients (2.7%) showed pathologic complete response (pCR; CAP grade 0 or Evans grade IV), 36 cases (16.1%) had minimal residual tumor (CAP grade 1 or Evans grade III), 124 cases (55.6%) had moderate response (CAP grade 2 or Evans grade IIb), and 57 cases (25.6%) had poor response (CAP grade 3, where 18 had Evans grade I and 39 had Evans grade IIa response). Patients with pCR or minimal residual tumor (response group 1) had better survival rates than those with moderate and poor response (response group 2). Response group 1 patients had lower posttherapy tumor and American Joint Committee on Cancer stages and lower rates of lymph node metastasis, positive resection margin, and recurrence and/or metastasis. Grading the extent of residual tumor is an independent prognostic factor for overall survival in multivariate analysis.
pCR or minimal residual tumor in posttreatment PD specimens correlate with better survival in patients with pancreatic ductal adenocarcinoma who received neoadjuvant therapy and PD. Histologic grading of the extent of residual tumor in PD specimen is an important prognostic factor in patients with pancreatic ductal adenocarcinoma who received neoadjuvant therapies.
已经提出了几种用于术后胰十二指肠切除术（PD）标本中残留肿瘤程度的分级方案。然而，这些分级方案的预后意义尚不清楚。
回顾了 223 例接受新辅助放化疗和 PD 的患者的组织病理学切片。使用美国病理学家学院（CAP）和 Evans 分级系统对残留肿瘤的程度进行分级。将分级结果与临床病理参数和生存相关联。
在 223 例患者中，有 6 例（2.7%）表现出病理完全缓解（CAP 分级 0 或 Evans 分级 IV），36 例（16.1%）有微小残留肿瘤（CAP 分级 1 或 Evans 分级 III），124 例（55.6%）有中度反应（CAP 分级 2 或 Evans 分级 IIb），57 例（25.6%）有较差反应（CAP 分级 3，其中 18 例为 Evans 分级 I，39 例为 Evans 分级 IIa）。具有 pCR 或微小残留肿瘤（反应组 1）的患者比具有中度和较差反应的患者（反应组 2）具有更好的生存率。反应组 1 患者的术后肿瘤和美国癌症联合委员会分期较低，淋巴结转移、阳性切缘、复发和/或转移的发生率较低。在多变量分析中，分级残留肿瘤的程度是总生存的独立预后因素。
接受新辅助治疗和 PD 的胰腺导管腺癌患者，术后 PD 标本中的 pCR 或微小残留肿瘤与更好的生存相关。新辅助治疗后 PD 标本中残留肿瘤程度的组织学分级是胰腺导管腺癌患者的重要预后因素。
