肿瘤退缩分级会影响ypT3期直肠癌的生存结局吗？

Can tumor regression grade influence survival outcome in ypT3 rectal cancer?

作者信息

Shen L, Wang L, Li G, Zhang H, Liang L, Fan M, Wu Y, Deng W, Sheng W, Zhu J, Zhang Z

机构信息

Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.

Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.

出版信息

Clin Transl Oncol. 2016 Jul;18(7):693-9. doi: 10.1007/s12094-015-1419-3. Epub 2015 Nov 2.

DOI:10.1007/s12094-015-1419-3

PMID:26527031

Abstract

PURPOSE

Locally advanced rectal cancer (LARC) patients achieving ypT3 status following neoadjuvant chemoradiation are considered to have poor response with minimal downstaging. However, residual cancer cell amounts vary in the subserosa/perirectal fat. Tumor regression grading (TRG) is an evaluation method based on the proportion of fibrosis and residual cancer cells. The aim of this study is to assess the influence of TRG in ypT3 rectal cancer patients who received neoadjuvant chemoradiation.

METHODS

We retrospectively reviewed 325 LARC patients who received neoadjuvant chemoradiation and surgery. TRG scores were recorded by two independent pathologists. Among these patients, 143 were staged as ypT3. We analyzed TRG and other clinicopathological factors and their relationship with survival outcome including overall survival (OS) and disease-free survival (DFS).

RESULTS

Among 143 ypT3 patients, 44 (30.8 %) were TRG1, 84 (58.7 %) were TRG2 and 15 (10.5 %) were TRG3. Seventy-nine (55.3 %) of these patients had metastatic lymph nodes. In univariate analysis, TRG was not associated with DFS (TRG2 vs TRG1, P = 0.852; TRG3 vs TRG1, P = 0.593) or OS (TRG2 vs TRG1, P = 0.977; TRG3 vs TRG1, P = 0.665). Palliative surgery (HR 3.845; 95 % CI 1.670-8.857; P = 0.002) and metastatic lymph nodes after surgery (HR 5.894; 95 % CI 1.142-3.48; P = 0.015) were significantly associated with decreased DFS, while palliative surgery was the only factor associated with worse OS (HR 6.011; 95 % CI 2.150-16.810; P = 0.001). Palliative surgery (HR 3.923; 95 % CI 1.696-9.073; P = 0.001) and metastatic lymph nodes (HR 2.011; 95 % CI 1.152-3.512; P = 0.014) also showed prognostic significance for DFS in multivariate analysis.

CONCLUSIONS

Residual cancer cells evaluated by TRG score after neoadjuvant chemoradiation do not influence survival outcome in ypT3 rectal cancer patients. However, lymph node status is a significant prognostic factor in ypT3 patients.

摘要

目的

新辅助放化疗后达到ypT3状态的局部晚期直肠癌（LARC）患者被认为反应较差，分期降低不明显。然而，浆膜下/直肠周围脂肪中的残留癌细胞数量各不相同。肿瘤退缩分级（TRG）是一种基于纤维化和残留癌细胞比例的评估方法。本研究的目的是评估TRG对接受新辅助放化疗的ypT3期直肠癌患者的影响。

方法

我们回顾性分析了325例接受新辅助放化疗和手术的LARC患者。TRG评分由两名独立的病理学家记录。在这些患者中，143例分期为ypT3。我们分析了TRG和其他临床病理因素及其与生存结局（包括总生存期（OS）和无病生存期（DFS））的关系。

结果

在143例ypT3患者中，44例（30.8%）为TRG1，84例（58.7%）为TRG2，15例（10.5%）为TRG3。这些患者中有79例（55.3%）有转移性淋巴结。单因素分析中，TRG与DFS（TRG2 vs TRG1，P = 0.852；TRG3 vs TRG1，P = 0.593）或OS（TRG2 vs TRG1，P = 0.977；TRG3 vs TRG1，P = 0.665）无关。姑息性手术（HR 3.845；95%CI 1.670 - 8.857；P = 0.002）和术后转移性淋巴结（HR 5.894；95%CI 1.142 - 3.48；P = 0.015）与DFS降低显著相关，而姑息性手术是与OS较差相关的唯一因素（HR 6.011；95%CI 2.150 - 16.810；P = 关于DFS，姑息性手术（HR 3.923；95%CI 1.696 - 9.073；P = 0.001）和转移性淋巴结（HR 2.011；95%CI 1.152 - 3.512；P = 0.014）在多因素分析中也显示出预后意义。