Wedemeyer I, Kreppel M, Scheer M, Zöller J E, Büttner R, Drebber U
Department of Pathology, University of Cologne, Cologne, Germany; Center of Integrated Oncology (CIO) Cologne-Bonn, Cologne, Germany.
Oral Dis. 2014 Apr;20(3):e81-9. doi: 10.1111/odi.12137. Epub 2013 Jun 9.
In advanced oral squamous cell carcinoma (OSCC), tumour regression after neoadjuvant radiochemotherapy seems to be an important prognostic factor. In this study, we intended to compare regression grading according to two previously described regression models and to analyse the association of tumour regression and other tumour characteristics with patients' characteristics and overall survival.
The retrospective study included 63 treatment-naive patients with primary OSCC of stages II-IV, who were treated with a concomitant neoadjuvant radiochemotherapy followed by radical surgery. Assessment of histopathological features was performed, there under regression grading according to two previously described regression models.
Both tumour regression models provided comparable results in terms of distribution of different regression grades. In univariate analysis regression gradings (P = 0.003 and P = 0.007), ypT-stage, ypN-stage and status of resection margins (P < 0.001) were significantly associated with the 5-year overall survival (OS). None of the pretreatment clinicopathological parameters showed association with histopathological tumour regression. Multivariate analysis revealed the status of resection margins and of lymph node metastasis as statistically significant features for OS (P = 0.020 and P = 0.003, respectively).
Tumour regression grading, nodal stage and status of resection margins predict prognosis in patients after neoadjuvant treatment. Currently, there are no pretreatment clinicopathological parameters, which predicting good tumour response to therapy. Thus, identifying non-responding patients, which might benefit from an intensified systemic therapy, requires surgical resection and consecutive histopathological assessment. Therefore, further investigation and validation of new, especially, molecular predictors of tumour response to radiochemotherapy remains an unmet, future clinical need.
在晚期口腔鳞状细胞癌（OSCC）中，新辅助放化疗后的肿瘤退缩似乎是一个重要的预后因素。在本研究中，我们旨在比较根据两种先前描述的退缩模型进行的退缩分级，并分析肿瘤退缩及其他肿瘤特征与患者特征和总生存的关联。
这项回顾性研究纳入了63例未经治疗的II-IV期原发性OSCC患者，他们接受了新辅助同步放化疗，随后进行根治性手术。对组织病理学特征进行了评估，包括根据两种先前描述的退缩模型进行退缩分级。
就不同退缩分级的分布而言，两种肿瘤退缩模型提供了可比的结果。在单因素分析中，退缩分级（P = 0.003和P = 0.007）、ypT分期、ypN分期和手术切缘状态（P < 0.001）与5年总生存（OS）显著相关。术前临床病理参数均未显示与组织病理学肿瘤退缩相关。多因素分析显示，手术切缘状态和淋巴结转移状态是OS的统计学显著特征（分别为P = 0.020和P = 0.003）。
肿瘤退缩分级、淋巴结分期和手术切缘状态可预测新辅助治疗后患者的预后。目前，尚无术前临床病理参数可预测肿瘤对治疗的良好反应。因此，识别可能从强化全身治疗中获益的无反应患者需要手术切除及后续组织病理学评估。因此，对新的，尤其是肿瘤对放化疗反应的分子预测指标进行进一步研究和验证仍然是未满足的未来临床需求。
