Langer Rupert, Becker Karen
Institute of Pathology, University of Bern, Murtenstrasse 31, 3008, Bern, Switzerland.
Institute of Pathology, Technische Universität München, Trogerstrasse 18, 81675, München, Germany.
Virchows Arch. 2018 Feb;472(2):175-186. doi: 10.1007/s00428-017-2232-x. Epub 2017 Sep 16.
Neoadjuvant therapy has been successfully introduced in the treatment of locally advanced gastrointestinal malignancies, particularly esophageal, gastric, and rectal cancers. The effects of preoperative chemo- or radiochemotherapy can be determined by histopathological investigation of the resection specimen following this treatment. Frequent histological findings after neoadjuvant therapy include various amounts of residual tumor, inflammation, resorptive changes with infiltrates of foamy histiocytes, foreign body reactions, and scarry fibrosis. Several tumor regression grading (TRG) systems, which aim to categorize the amount of regressive changes after cytotoxic treatment in primary tumor sites, have been proposed for gastroesophageal and rectal carcinomas. These systems primarily refer to the amount of therapy-induced fibrosis in relation to the residual tumor (e.g., the Mandard, Dworak, or AJCC systems) or the estimated percentage of residual tumor in relation to the previous tumor site (e.g., the Becker, Rödel, or Rectal Cancer Regression Grading systems). TRGs provide valuable prognostic information, as in most cases, complete or subtotal tumor regression after neoadjuvant treatment is associated with better patient outcomes. This review describes the typical histopathological findings after neoadjuvant treatment, discusses the most commonly used TRG systems for gastroesophageal and rectal carcinomas, addresses the limitations and critical issues of tumor regression grading in these tumors, and describes the clinical impact of TRG.
新辅助治疗已成功应用于局部晚期胃肠道恶性肿瘤的治疗，尤其是食管癌、胃癌和直肠癌。术前化疗或放化疗的效果可通过对治疗后切除标本的组织病理学检查来确定。新辅助治疗后常见的组织学表现包括不同程度的残留肿瘤、炎症、伴有泡沫状组织细胞浸润的吸收性改变、异物反应和瘢痕性纤维化。针对胃食管癌和直肠癌，已经提出了几种肿瘤退缩分级（TRG）系统，旨在对原发肿瘤部位细胞毒性治疗后的退缩变化程度进行分类。这些系统主要参考与残留肿瘤相关的治疗诱导纤维化程度（例如，Mardard、Dworak或美国癌症联合委员会（AJCC）系统），或与先前肿瘤部位相关的残留肿瘤估计百分比（例如，Becker、Rödel或直肠癌退缩分级系统）。TRG提供了有价值的预后信息，因为在大多数情况下，新辅助治疗后肿瘤的完全或部分退缩与患者更好的预后相关。本综述描述了新辅助治疗后的典型组织病理学表现，讨论了胃食管癌和直肠癌最常用的TRG系统，阐述了这些肿瘤退缩分级的局限性和关键问题，并描述了TRG的临床影响。
