Division of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.
World J Surg. 2012 Mar;36(3):675-83. doi: 10.1007/s00268-011-1409-8.
This study evaluated the impact of tumor regression grading (TRG) and other pathologic variates in a cohort of rectal carcinoma patients treated with neoadjuvant chemoradiotherapy (CRT). The value of a grading less than pCR for predicting survival is unknown. Tumor budding has not been systematically studied in rectal cancer after neoadjuvant therapy.
Pathologic risk factors for survival were evaluated on surgical specimens of 237 patients with stages I, II, and III rectal cancer treated between 1996 and 2006. All patients underwent preoperative CRT followed by surgical resection 6-8 weeks later. TRG, tumor grade, budding, venous invasion, radial margin, and nodal status were evaluated. The prognostic value of TRG categories was calculated with Cox regression models and validated with resampling methods.
TRG of <25% occurred in 61 (25.7%) and a complete response in 39 (16.4%) of the resected specimens. TRG of <25% was shown to be a statistically significant predictor for cancer-specific survival (CSS) and recurrence-free survival (RFS) compared to TRG ≥25% (P = 0.013). Tumor budding was present in 24 (10.1%) of the patients and was negatively associated with CSS (P = 0.013). Lymph node involvement was observed in 83 (35.0%) patients. TRG and nodal status (P < 0.001) were the most significant predictors associated with outcome.
Partial pathologic response ≥25% was a superior predictor compared to pCR for improved survival after preoperative CRT. CSS and RFS were adversely affected by the presence of lymph node metastases.
本研究评估了新辅助放化疗（CRT）治疗的直肠癌患者队列中肿瘤消退分级（TRG）和其他病理变量的影响。分级低于 pCR 预测生存的价值尚不清楚。肿瘤芽殖在新辅助治疗后的直肠癌中尚未得到系统研究。
评估了 237 例 1996 年至 2006 年间接受术前 CRT 治疗的 I、II 和 III 期直肠癌患者手术标本的生存病理危险因素。所有患者均接受术前 CRT，6-8 周后行手术切除。评估 TRG、肿瘤分级、芽殖、静脉侵犯、放射状边缘和淋巴结状态。使用 Cox 回归模型计算 TRG 分类的预后价值，并通过重采样方法进行验证。
<25%的 TRG 发生率为 61 例（25.7%），完全缓解率为 39 例（16.4%）。与 TRG≥25%相比，<25%的 TRG 被证明是癌症特异性生存（CSS）和无复发生存（RFS）的统计学显著预测因子（P=0.013）。24 例（10.1%）患者存在肿瘤芽殖，与 CSS 呈负相关（P=0.013）。83 例（35.0%）患者有淋巴结受累。TRG 和淋巴结状态（P<0.001）是与预后最显著相关的预测因子。
与 pCR 相比，术前 CRT 后≥25%的部分病理反应是改善生存的更好预测因子。CSS 和 RFS 受淋巴结转移的不利影响。
