Zhu Yuelu, Sun Yongkun, Hu Shangying, Jiang Yong, Yue Jiangying, Xue Xuemin, Yang Lin, Xue Liyan
Department of Pathology and Resident Training Base, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Medical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
BMC Gastroenterol. 2017 Mar 14;17(1):41. doi: 10.1186/s12876-017-0598-5.
Neoadjuvant chemotherapy has been increasingly practiced on gastric cancer (GC), and histological evaluation to predict outcome is urgent in clinical practice. There are five classic tumor regression grading (TRG) systems, including Mandard-TRG system, the Japanese Gastric Cancer Association (JGCA)-TRG system, College of American Pathologists (CAP)-TRG system, China-TRG system and Becker-TRG system.
Totally, 192 patients of gastric adenocarcinoma (including adenocarcinoma of the esophagogastric junction) treated by neoadjuvant chemotherapy and surgery were evaluated using the above five TRG systems. The clinicopathological characteristics were also assessed. The correlation among TRG systems, clinicopathological characteristics and prognosis were analyzed.
All the five TRG systems were significantly correlated with differentiation, postsurgical T category, postsurgical N category, American Joint Committee on Cancer (AJCC) stage, lymph-vascular invasion, perineural invasion, as well as tumor size. All the five TRG systems were statistically significant in univariate Cox survival analysis. However, only postsurgical T category, postsurgical N category and R0 resection were independent in multivariate Cox survival analysis. The tight correlation between the TRG systems and other characteristics such as postsurgical stage might affect the independent prognostic role of the TRG systems. As compared with other TRG systems, the hazard ratio of no/slightly response in both Mandard TRG system and JGCA TRG system revealed higher hazard of death and disease progression than that of severe response when using univariate Cox survival analysis. The median survival time of complete response and nearly complete response were much longer than that of partial response, all classified by Mandard-TRG system. This could help clinicians predict prognosis more reasonably than JGCA-TRG which does not have the category of nearly complete response.
We recommend Mandard-TRG system for GC after neoadjuvant chemotherapy due to its better prediction of prognosis.
新辅助化疗在胃癌（GC）治疗中应用日益广泛，临床实践中迫切需要通过组织学评估来预测预后。目前有五种经典的肿瘤退缩分级（TRG）系统，包括曼德尔（Mardard）-TRG系统、日本胃癌协会（JGCA）-TRG系统、美国病理学家学会（CAP）-TRG系统、中国-TRG系统和贝克尔（Becker）-TRG系统。
采用上述五种TRG系统对192例接受新辅助化疗和手术治疗的胃腺癌（包括食管胃交界腺癌）患者进行评估。同时评估患者的临床病理特征，并分析TRG系统、临床病理特征与预后之间的相关性。
所有五种TRG系统均与肿瘤分化程度、术后T分期、术后N分期、美国癌症联合委员会（AJCC）分期、脉管侵犯、神经侵犯以及肿瘤大小显著相关。在单因素Cox生存分析中，所有五种TRG系统均具有统计学意义。然而，在多因素Cox生存分析中，只有术后T分期、术后N分期和R0切除是独立的预后因素。TRG系统与术后分期等其他特征之间的紧密相关性可能会影响TRG系统的独立预后作用。在单因素Cox生存分析中，与其他TRG系统相比，曼德尔TRG系统和JGCA TRG系统中无/轻度反应的风险比显示，与重度反应相比，死亡和疾病进展的风险更高。根据曼德尔-TRG系统分类，完全缓解和接近完全缓解患者的中位生存时间远长于部分缓解患者。这比没有接近完全缓解分类的JGCA-TRG系统能帮助临床医生更合理地预测预后。
由于曼德尔-TRG系统对预后的预测效果更好，我们推荐将其用于新辅助化疗后的胃癌评估。
