Department of Surgery, Paracelsus Medical University, Muellner Hauptstraße 48, 5020, Salzburg, Austria.
Institute of Pathology, Paracelsus Medical University, Muellner Hauptstraße 48, 5020, Salzburg, Austria.
Strahlenther Onkol. 2018 Nov;194(11):991-1006. doi: 10.1007/s00066-018-1340-0. Epub 2018 Aug 1.
This study was conducted to investigate the potential predictive value of tumor budding for neoadjuvant chemoradiotherapy response in locally advanced rectal cancer.
Surgical specimens of 128 ypUICC (Union for International Cancer Control) stage 0-III mid-to-low rectal cancer patients were identified from a prospectively maintained colorectal cancer database and classified into two groups using the 10 high-power field average method: none/mild tumor budding (BD-0) and moderate/severe tumor budding (BD-1). Overall survival, relapse-free survival (RFS), and recurrence estimates were calculated using the Kaplan-Meier method and compared with the log-rank test. For RFS, a multivariable Cox's proportional hazards regression analysis was performed.
No (n = 20) or mild (n = 27) tumor budding (BD-0) was identified in 47 (37%) and moderate (n = 52) or severe (n = 29) tumor budding (BD-1) in 81 (63%) surgical specimens. Positive tumor budding (BD-1) was associated with significantly reduced T‑level downstaging (P < 0.001) and tumor regression (P < 0.001). After a median follow-up time of 7 years (range 2.9-146.7 months), BD-0 patients had more favorable 5‑year RFS (90 vs. 71%, P = 0.02) and distant recurrence (2 vs. 12%, P = 0.03) estimates. Multivariable analyses confirmed BD-1 as a negative predictive parameter for RFS (hazard ratio = 3.44, 95% confidence interval 1.23-9.63, P = 0.018).
Our data confirm tumor budding as a strong prognostic factor and its potential predictive value for neoadjuvant chemoradiotherapy response in locally advanced rectal cancer patients. This provides the opportunity to modify and individualize neoadjuvant therapy regimens for non-responders.
本研究旨在探讨肿瘤芽殖对局部进展期直肠癌新辅助放化疗反应的潜在预测价值。
从一个前瞻性维持的结直肠癌数据库中确定了 128 例 ypUICC（国际癌症控制联盟）分期 0-III 期中低位直肠癌患者的手术标本，并使用 10 个高倍视野平均法将其分为两组：无/轻度肿瘤芽殖（BD-0）和中度/重度肿瘤芽殖（BD-1）。使用 Kaplan-Meier 方法计算总生存、无复发生存（RFS）和复发估计，并使用对数秩检验进行比较。对于 RFS，进行了多变量 Cox 比例风险回归分析。
在 47 例（37%）手术标本中未发现（n=20）或轻度肿瘤芽殖（n=27）（BD-0），在 81 例（63%）手术标本中发现中度（n=52）或重度肿瘤芽殖（BD-1）（n=29）。阳性肿瘤芽殖（BD-1）与 T 级降期（P<0.001）和肿瘤退缩（P<0.001）显著相关。中位随访时间为 7 年（范围 2.9-146.7 个月）后，BD-0 患者的 5 年 RFS（90% vs. 71%，P=0.02）和远处复发（2% vs. 12%，P=0.03）估计值更有利。多变量分析证实 BD-1 是 RFS 的负预测参数（危险比=3.44，95%置信区间 1.23-9.63，P=0.018）。
我们的数据证实肿瘤芽殖是一个强有力的预后因素，并具有预测局部进展期直肠癌患者新辅助放化疗反应的潜力。这为修改和个体化非反应者的新辅助治疗方案提供了机会。
