经新辅助放化疗后接受切除术的直肠癌患者，残留肿瘤负担评估的量化病理反应是无复发生存率的预测指标。
Quantified pathologic response assessed as residual tumor burden is a predictor of recurrence-free survival in patients with rectal cancer who undergo resection after neoadjuvant chemoradiotherapy.
机构信息
Department of Pathology, Baylor College of Medicine, Houston, Texas.
出版信息
Cancer. 2013 Dec 15;119(24):4231-41. doi: 10.1002/cncr.28331. Epub 2013 Oct 1.
BACKGROUND
The current study was conducted to determine whether quantified pathologic response assessed as a percentage of residual tumor cells is predictive of recurrence-free survival (RFS) in patients with rectal cancer.
METHODS
The authors studied 251 patients with rectal adenocarcinoma who were treated with neoadjuvant chemoradiation and radical resection. Quantified pathologic response was defined as an estimated percentage of residual cancer cells in relation to the tumor bed: complete, no residual cancer cells; near-complete, ≤ 5% residual cancer cells; major, > 5%, and < 50% residual cancer cells; and minor, ≥ 50% residual cancer cells. The reproducibility of quantified pathologic response between 2 pathologists was assessed using tumors from 55 randomly selected patients who did not demonstrate a complete response.
RESULTS
Pathologic response was complete in 21% of patients, near-complete in 20% of patients, major in 37% of patients, and minor in 22% of patients. Nineteen percent of patients had ypT0N0 disease, 27% had ypT1-2N0 disease, 21% had ypT3-4N0 disease, and 33% had N+ disease. The 5-year RFS rates by category of quantified pathologic response were as follows: complete, 95%; near-complete, 88%; major, 69%; and minor, 61% (P < .001). Major and minor response, high histologic grade, and perineural invasion were found to be significant predictors of decreased RFS on multivariate analysis. The 5-year RFS rates for patients with ypT3-4 or N+ disease were better for those with a near-complete response (94%) compared with those with a major (64%) or minor (61%) response (P < .02). Moderate to substantial agreement was observed between the 2 pathologists (κ = 0.72).
CONCLUSIONS
Quantified pathologic response is a predictor of RFS in patients with rectal adenocarcinoma and stratifies patients with high pathologic stage disease.
背景
本研究旨在确定经新辅助放化疗和根治性切除术治疗的直肠腺癌患者，肿瘤细胞残留百分比的量化病理反应是否可预测无复发生存率（RFS）。
方法
作者研究了 251 例接受新辅助放化疗和根治性切除术治疗的直肠腺癌患者。量化病理反应定义为相对于肿瘤床的残留癌细胞估计百分比：完全，无残留癌细胞；接近完全，≤5%残留癌细胞；主要，>5%且<50%残留癌细胞；次要，≥50%残留癌细胞。通过 55 例随机选择且未显示完全缓解的患者的肿瘤评估了 2 位病理学家之间量化病理反应的可重复性。
结果
21%的患者病理反应完全，20%的患者接近完全，37%的患者主要，22%的患者次要。19%的患者为ypT0N0 疾病，27%的患者为 ypT1-2N0 疾病，21%的患者为 ypT3-4N0 疾病，33%的患者为 N+疾病。量化病理反应类别与 RFS 率如下：完全反应，95%；接近完全反应，88%；主要反应，69%；次要反应，61%（P<0.001）。多变量分析显示，主要和次要反应、高组织学分级和神经周围侵犯是 RFS 降低的显著预测因素。ypT3-4 或 N+疾病患者的 5 年 RFS 率，接近完全反应者（94%）优于主要反应者（64%）和次要反应者（61%）（P<0.02）。两位病理学家之间存在中度到高度一致性（κ=0.72）。
结论
量化病理反应是直肠腺癌患者 RFS 的预测指标，并对高病理分期疾病的患者进行分层。
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