Suzuki Toshiyuki, Sadahiro Sotaro, Tanaka Akira, Okada Kazutake, Saito Gota, Miyakita Hiroshi, Akiba Takeshi, Yamamuro Hiroshi
Department of Surgery, Tokai University School of Medicine, Isehara, Japan.
Oncology. 2017;93(5):287-294. doi: 10.1159/000478266. Epub 2017 Jul 21.
The histologic response to neoadjuvant chemoradiotherapy (CRT) has been intimately related to outcomes in locally advanced rectal cancer. However, reliable prognostic factors have yet to be established.
The study group comprised 198 patients with locally advanced rectal cancer who received CRT. A modified classification based on the combination of ypStage and tumor regression grade (TRG) was developed. ypStage II with TRG 2 was classified as ypTRGstage IIA, and ypStage II with TRG 3 or 4 was classified as ypTRGstage IIB. ypStage 0 and ypStage I were classified as ypTRGstage I, and ypStage III was classified as ypTRGstage III.
The 5-year disease-free survival (DFS) was 83% in ypTRGstage I, 86% in ypTRGstage IIA, 57% in ypTRGstage IIB, and 60% in ypTRGstage III (p = 0.0001). The 5-year DFS in ypTRGstage IIA did not differ significantly from that in ypStage 0 (p = 0.865) or ypStage I (p = 0.585). The 5-year DFS in ypStage IIB did not differ from that in ypStage III (p = 0.912). Multivariate analysis showed that ypTRGstage was an independent risk factor for DFS.
A modified classification allows patients with ypStage II locally advanced rectal cancer to be clearly divided into two groups: responders and nonresponders.
新辅助放化疗（CRT）的组织学反应与局部晚期直肠癌的预后密切相关。然而，可靠的预后因素尚未确立。
研究组包括198例接受CRT的局部晚期直肠癌患者。基于yp分期和肿瘤退缩分级（TRG）的组合制定了一种改良分类法。yp分期II且TRG为2分类为ypTRG分期IIA，yp分期II且TRG为3或4分类为ypTRG分期IIB。yp分期0和yp分期I分类为ypTRG分期I，yp分期III分类为ypTRG分期III。
ypTRG分期I的5年无病生存率（DFS）为83%，ypTRG分期IIA为86%，ypTRG分期IIB为57%，ypTRG分期III为60%（p = 0.0001）。ypTRG分期IIA的5年DFS与yp分期0（p = 0.865）或yp分期I（p = 0.585）相比无显著差异。yp分期IIB的5年DFS与yp分期III相比无差异（p = 0.912）。多因素分析显示ypTRG分期是DFS的独立危险因素。
改良分类法可将yp分期II的局部晚期直肠癌患者明确分为两组：反应者和无反应者。
