局部晚期直肠癌放化疗后的肿瘤退缩分级：接近病理完全缓解并不意味着良好的临床结局。

Tumour regression grading after chemoradiotherapy for locally advanced rectal cancer: a near pathologic complete response does not translate into good clinical outcome.

作者信息

Swellengrebel Hendrik A M, Bosch Steven L, Cats Annemieke, Vincent Andrew D, Dewit Luc G H, Verwaal Vic J, Nagtegaal Iris D, Marijnen Corrie A M

机构信息

Department of Gastroenterology and Hepatology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.

Department of Pathology, Radboud University Nijmegen Medical Centre, The Netherlands.

出版信息

Radiother Oncol. 2014 Jul;112(1):44-51. doi: 10.1016/j.radonc.2014.05.010. Epub 2014 Jul 10.

DOI:10.1016/j.radonc.2014.05.010

PMID:25018000

Abstract

BACKGROUND

After preoperative chemoradiotherapy (CRT) for rectal cancer, clinically undetectable residual tumour deposits or pathologic lymph nodes may remain in the mesorectum.

AIM

The aim of this study was to report histopathological effects of CRT and factors affecting outcome in a uniformly treated series of locally advanced rectal cancer (LARC) patients.

METHODS

Between 2004 and 2008, 107 patients with cT3 (threatening the mesorectal fascia or <5 cm from the anal verge), cT4 or cN2 rectal cancer were treated with preoperative CRT (25 × 2 Gy with capecitabine) and TME 6-8 weeks later. Central histopathological review followed. Tumour regression grade (TRG) was scored in pCR, near-pCR, response and no response. Cox regression was performed to identify prognosticators.

RESULTS

The 3-year distant metastasis-free interval, disease-free rate and overall survival rate were 82%, 73% and 87% (median 44 months follow-up). TRG consisted of 20% pCR, 11% near-pCR, 55% response and 14% no response. 6/21 pCR patients harboured nodal metastases. 5/12 near-pCR had ypT3 disease, while 6 harboured node metastases. 5/12 near-PCR patients developed distant metastases. ypN and TRG were powerful outcome discriminators.

CONCLUSION

The high number of near-pCR with ypT3 or ypN1/2 and their poor outcome demonstrates that "watch-and-wait" in LARC patients should be applied with care.

摘要

背景

直肠癌术前放化疗（CRT）后，直肠系膜内可能仍存在临床无法检测到的残留肿瘤沉积物或病理淋巴结。

目的

本研究旨在报告CRT的组织病理学效应以及影响一组接受统一治疗的局部晚期直肠癌（LARC）患者预后的因素。

方法

2004年至2008年期间，107例cT3（侵犯直肠系膜筋膜或距肛缘<5 cm）、cT4或cN2期直肠癌患者接受了术前CRT（25×2 Gy联合卡培他滨），6 - 8周后行全直肠系膜切除术（TME）。随后进行中心组织病理学评估。对病理完全缓解（pCR）、接近pCR、有反应和无反应的患者进行肿瘤退缩分级（TRG）评分。采用Cox回归分析确定预后因素。

结果

3年无远处转移生存期、无病生存率和总生存率分别为82%、73%和87%（中位随访44个月）。TRG包括20%的pCR、11%的接近pCR、55%的有反应和14%的无反应。21例pCR患者中有6例存在淋巴结转移。12例接近pCR患者中有5例为ypT3期疾病，6例存在淋巴结转移。12例接近pCR患者中有5例发生远处转移。ypN和TRG是强有力的预后判别指标。