接受新辅助放化疗的食管鳞状细胞癌患者肿瘤退缩分级与临床病理参数的相关性

Correlation Between Tumor Regression Grade and Clinicopathological Parameters in Patients With Squamous Cell Carcinoma of the Esophagus Who Received Neoadjuvant Chemoradiotherapy.

作者信息

Chao Yin-Kai, Chang Chun-Bi, Chuang Wen-Yu, Wen Yu-Wen, Chang Hsien-Kun, Tseng Chen-Kan, Yeh Chi-Ju, Liu Yun-Hen

机构信息

From the Division of Thoracic Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan (Y-KC, Y-JL); Department of Radiology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan (C-BC); Department of Pathology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan (W-YC, C-JY); Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyuan, Taiwan (Y-WW); Division of Hematology/Oncology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan (H-KC); Department of Radiation Oncology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan (C-KT).

出版信息

Medicine (Baltimore). 2015 Aug;94(34):e1407. doi: 10.1097/MD.0000000000001407.

The aim of this study was 2-fold: first, to assess the prognostic significance on overall survival (OS) of the 3-point tumor regression grade (TRG) in patients with esophageal squamous cell carcinoma (ESCC) who received neoadjuvant chemoradiotherapy (nCRT); second, to investigate the associations of TRG with the clinicopathological characteristics of the study patients.A total of 357 ESCC patients were retrospectively enrolled. The 3-point TRG was determined by assessing the percentage of viable residual tumor cells (VRTC) in the resected specimens as follows: TRG 1, 0% VRTC; TRG 2, 1% to 50% VRTC; and TRG 3, >50% VRTC.A TRG of 1, 2, and 3 was found in 32.2%, 38.9%, and 28.9% of the specimens, respectively. High TRG values were significantly associated with advanced pretreatment clinical stage, longer tumor length, and higher posttreatment tumor depth of invasion (yT), the presence of lymph node metastases (LNM), and lymphovascular invasion. We observed a stepwise decrease in 5-year OS rates with increasing TRG, as follows: 51% for patients with a TRG of 1, 28% for patients with a TRG of 2, and 22% for patients with a TRG of 3 (P < 0.001). TRG and LNM were independent predictors of OS in multivariate analysis. Notably, the prognostic impact of TRG on OS was greater in patients without LNM (P < 0.001) and ypT3 disease (P = 0.021).TRG is independently associated with OS in ESCC patients treated with nCRT. The interrelationships between TRG, LNM, and depth of tumor invasion may improve the prognostic stratification in esophageal cancer.

本研究的目的有两个

第一，评估接受新辅助放化疗（nCRT）的食管鳞状细胞癌（ESCC）患者的三分肿瘤消退分级（TRG）对总生存期（OS）的预后意义；第二，研究TRG与研究患者临床病理特征的相关性。

共回顾性纳入357例ESCC患者。三分TRG通过评估切除标本中存活残余肿瘤细胞（VRTC）的百分比来确定，如下：TRG 1，VRTC为0%；TRG 2，VRTC为1%至50%；TRG 3，VRTC＞50%。

分别在32.2%、38.9%和28.9%的标本中发现TRG为1、2和3。高TRG值与治疗前临床分期较晚、肿瘤长度较长、治疗后肿瘤浸润深度（yT）较高、存在淋巴结转移（LNM）和淋巴管浸润显著相关。

我们观察到随着TRG增加，5年总生存率呈逐步下降，如下：TRG为1的患者为51%，TRG为2的患者为28%，TRG为3的患者为22%（P＜0.001）。在多变量分析中，TRG和LNM是OS的独立预测因素。值得注意的是，TRG对OS的预后影响在无LNM患者（P＜0.001）和ypT3期疾病患者（P = 0.021）中更大。

在接受nCRT治疗的ESCC患者中，TRG与OS独立相关。TRG、LNM和肿瘤浸润深度之间的相互关系可能会改善食管癌的预后分层。