中国局部晚期直肠癌术前放化疗后美国癌症联合委员会（AJCC）肿瘤退缩分级系统的病理评估

Pathological Assessment of the AJCC Tumor Regression Grading System After Preoperative Chemoradiotherapy for Chinese Locally Advanced Rectal Cancer.

作者信息

Zhang Lu-Ning, Xiao Wei-Wei, Xi Shao-Yan, OuYang Pu-Yun, You Kai-Yun, Zeng Zhi-Fan, Ding Pei-Rong, Zhang Hui-Zhong, Pan Zhi-Zhong, Xu Rui-Hua, Gao Yuan-Hong

机构信息

From the Department of Radiation Oncology (L-NZ, W-WX, P-YOY, Z-FZ, Y-HG), Department of Colorectal Surgery (Z-ZP), Department of Medical Oncology (R-HX), and Department of Pathological Oncology (S-YX, H-ZZ), Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China; and Department of Oncology, The Second Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (K-YY).

出版信息

Medicine (Baltimore). 2016 Jan;95(3):e2272. doi: 10.1097/MD.0000000000002272.

DOI:10.1097/MD.0000000000002272

PMID:26817863

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4998237/

Abstract

We used American Joint Committee on Cancer (AJCC) Staging Manual system to assess the prognostic significance of tumor regression grading (TRG) for locally advanced rectal cancer (LARC) (T3/4 or N+) patients who were treated with preoperative chemoradiotherapy (CRT).The 4 AJCC-TRG classifications were evaluated on surgical specimens from 295 LARC patients receiving CRT. Overall survival (OS), disease-free survival (DFS), local recurrence-free survival (LRFS), and distant metastasis-free survival (DMFS) were estimated using Kaplan-Meier method and Cox regression model.Classifications of TRG 0, 1, 2, and 3 were found in 27.5%, 19.3%, 45.7%, and 7.5% of the resected specimens, respectively. Three-year OS was 95.5% for TRG0, 91.5% for TRG1, 84.8% for TRG2, and 85.7% for TRG3 (P = 0.035). Three-year DFS was 89.0% for TRG0, 74.4% for TRG1, 70.9% for TRG2, and 62% for TRG3 (P = 0.018). By multivariate analysis, AJCC-TRG (P = 0.033), residual lymph node metastasis (ypN+) (P < 0.001) and pretreatment CA19-9 level (P = 0.035) were significant predictors of OS. Pathological T category (P = 0.006) and nodal status (P < 0.001) after CRT were the most important independent prognostic factors for DFS.AJCC-TRG is a prognostic factor for LARC patients receiving CRT, independent of pathological staging.

摘要

我们采用美国癌症联合委员会（AJCC）分期手册系统，评估肿瘤退缩分级（TRG）对接受术前放化疗（CRT）的局部晚期直肠癌（LARC，T3/4或N+）患者的预后意义。对295例接受CRT的LARC患者的手术标本进行了4种AJCC-TRG分类评估。采用Kaplan-Meier法和Cox回归模型估计总生存期（OS）、无病生存期（DFS）、局部无复发生存期（LRFS）和远处无转移生存期（DMFS）。在切除标本中，TRG 0、1、2和3级的分类分别占27.5%、19.3%、45.7%和7.5%。TRG0的三年OS为95.5%，TRG1为91.5%，TRG2为84.8%，TRG3为85.7%（P = 0.035）。TRG0的三年DFS为89.0%，TRG1为74.4%，TRG2为70.9%，TRG3为62%（P = 0.018）。多因素分析显示，AJCC-TRG（P = 0.033）、残留淋巴结转移（ypN+）（P < 0.001）和治疗前CA19-9水平（P = 0.035）是OS的显著预测因素。CRT后的病理T分期（P = 0.006）和淋巴结状态（P < 0.001）是DFS最重要的独立预后因素。AJCC-TRG是接受CRT的LARC患者的一个预后因素，独立于病理分期。