Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany.
Department of Pathology, Technische Universitaet Muenchen, 81675 Munich, Germany.
Br J Cancer. 2014 Apr 2;110(7):1712-20. doi: 10.1038/bjc.2014.94. Epub 2014 Feb 25.
Recently, histopathological tumour regression, prevalence of signet ring cells, and localisation were reported as prognostic factors in neoadjuvantly treated oesophagogastric (junctional and gastric) cancer. This exploratory retrospective study analyses independent prognostic factors within a large patient cohort after preoperative chemotherapy including clinical and histopathological factors.
In all, 850 patients presenting with oesophagogastric cancer staged cT3/4 Nany cM0/x were treated with neoadjuvant chemotherapy followed by resection in two academic centres. Patient data were documented in a prospective database and retrospectively analysed.
Of all factors prognostic on univariate analysis, only clinical response, complications, ypTNM stage, and R category were independently prognostic (P<0.01) on multivariate analysis. Tumour localisation and signet ring cells were independently prognostic only when investigator-dependent clinical response evaluation was excluded from the multivariate model. Histopathological tumour regression correlates with tumour grading, Laurén classification, clinical response, ypT, ypN, and R categories but was not identified as an independent prognostic factor. Within R0-resected patients only surgical complications and ypTNM stage were independent prognostic factors.
Only established prognostic factors like ypTNM stage, R category, and complications were identified as independent prognostic factors in resected patients after neoadjuvant chemotherapy. In contrast, histopathological tumour regression was not found as an independent prognostic marker.
最近，有研究报道在接受新辅助治疗的食管胃（交界和胃）腺癌患者中，组织病理学肿瘤退缩、印戒细胞的存在和肿瘤定位是预后因素。本研究回顾性分析了包括临床和组织病理学因素在内的大型患者队列在术前化疗后的独立预后因素。
共 850 例 cT3/4 Nany cM0/x 期食管胃腺癌患者在两个学术中心接受新辅助化疗后行手术切除。患者数据记录在一个前瞻性数据库中，并进行回顾性分析。
在单因素分析中具有预后意义的所有因素中，只有临床反应、并发症、ypTNM 分期和 R 分类在多因素分析中是独立的预后因素（P<0.01）。当多因素模型排除研究者依赖的临床反应评估时，肿瘤定位和印戒细胞才是独立的预后因素。组织病理学肿瘤退缩与肿瘤分级、Laurén 分类、临床反应、ypT、ypN 和 R 分类相关，但未被确定为独立的预后因素。在 R0 切除的患者中，只有手术并发症和 ypTNM 分期是独立的预后因素。
只有 ypTNM 分期、R 分类和并发症等已确立的预后因素被确定为新辅助化疗后接受手术切除的患者的独立预后因素。相比之下，组织病理学肿瘤退缩未被发现是独立的预后标志物。
