新辅助放化疗后肿瘤退缩分级对一组局部晚期直肠癌患者的预后意义：一项为期8年的单机构回顾性研究。

Prognostic significance of tumour regression grade after neoadjuvant chemoradiotherapy for a cohort of patients with locally advanced rectal cancer: an 8-year retrospective single-institutional study.

作者信息

Xu L, Cai S, Xiao T, Chen Y, Qiu H, Wu B, Lin G, Sun X, Lu J, Zhou W, Xiao Y

机构信息

Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

Medical College of Soochow University, Suzhou, Jiangsu, China.

出版信息

Colorectal Dis. 2017 Jul;19(7):O263-O271. doi: 10.1111/codi.13757.

DOI:10.1111/codi.13757

PMID:28603932

Abstract

AIM

Locally advanced rectal cancer (LARC) is frequently treated with neoadjuvant chemoradiotherapy (NACRT) to reduce the risk of local recurrence and improve survival. Tumour response to NACRT is variable and may influence the prognosis after subsequent surgery. This study compared the prognostic values of tumour regression grade (TRG) and neoadjuvant pathological (ypTNM) downstaging in patients with Stage II and III rectal cancer treated with NACRT followed by curative surgery.

METHOD

This study included 185 patients with LARC treated with long-course radiotherapy (45 Gy in 25 fractions) plus 5-fluorouracil over 5 weeks between 2005 and 2013. We used multivariate analysis to assess the relationship of Dworak's five-tier TRG, ypTNM stage and ypTNM downstaging with clinicopathological factors, 5-year disease-free survival (DFS) and 5-year overall survival (OS).

RESULTS

Total regression (TRG4), good regression (TRG3), moderate regression (TRG2), minor regression (TRG1) and no regression (TRG0) were seen in 38 (20.6%), 65 (35.2%), 43 (23.2%), 28 (15.1%) and 11 (5.9%) patients, respectively. TNM downstaging following NACRT occurred in 109 (58.9%) patients. The 5-year DFS rates after NACRT for TRG0, TRG1, TRG2, TRG3 and TRG4 were 0%, 58.5%, 66.4%, 80.4% and 82.6%, respectively (P < 0.001). The ypTNM stage correlated with 5-year DFS (P = 0.004) but not 5-year OS (P = 0.075). Multivariate analysis demonstrated that TRG was related to both DFS and OS (P < 0.001).

CONCLUSION

TRG measured on a five-tier system was better than ypTNM stage for predicting outcome in patients with LARC treated with NACRT and surgery.

摘要

目的

局部晚期直肠癌（LARC）常采用新辅助放化疗（NACRT）以降低局部复发风险并提高生存率。肿瘤对NACRT的反应存在差异，可能会影响后续手术的预后。本研究比较了接受NACRT后行根治性手术的II期和III期直肠癌患者中肿瘤退缩分级（TRG）和新辅助病理（ypTNM）降期的预后价值。

方法

本研究纳入了2005年至2013年间185例接受长程放疗（25次分割，共45 Gy）加5氟尿嘧啶持续5周治疗的LARC患者。我们采用多因素分析评估Dworak五级TRG、ypTNM分期和ypTNM降期与临床病理因素、5年无病生存率（DFS）和5年总生存率（OS）之间的关系。

结果

分别有38例（20.6%）、65例（35.2%）、43例（23.2%）、28例（15.1%）和11例（5.9%）患者出现完全退缩（TRG4）、良好退缩（TRG3）、中度退缩（TRG2）、轻度退缩（TRG1）和无退缩（TRG0）。NACRT后ypTNM降期发生在109例（58.9%）患者中。NACRT后TRG0、TRG1、TRG2、TRG3和TRG4患者的5年DFS率分别为0%、58.5%、66.4%、80.4%和82.6%（P<0.001）。ypTNM分期与5年DFS相关（P = 0.004），但与5年OS无关（P = 0.075）。多因素分析表明，TRG与DFS和OS均相关（P<0.001）。