Department of Colorectal Surgery, Cleveland Clinic, Cleveland, OH.
Department of Anatomic Pathology, Cleveland Clinic, Cleveland, OH.
Ann Surg. 2019 Jun;269(6):1117-1123. doi: 10.1097/SLA.0000000000002719.
To evaluate the independent prognostic ability of the American Joint Committee on Cancer (AJCC) tumor regression scores within pathologic stage II and III rectal cancers.
Response to neoadjuvant chemoradiation (nCRT) has been debated as a biologic surrogate for tumor biology and prognosis in rectal cancer. AJCC regression scores have been shown to correlate with prognosis.
Patient demographics, tumor characteristics, and AJCC scores (0 = complete response; 1 = isolated tumor cells remaining; 2 = residual cancer outgrown by fibrosis; 3 = extensive residual cancer) were assessed from 545 rectal cancer patients treated by nCRT followed by surgery at a single institution. Patients were classified as responders (score 0-2) or nonresponders (score 3). Survival analyses were performed using Cox proportional hazards models.
Of 545 cases, 123 and 182 were pathologic stage II and III, respectively. Median follow-up was 4.9 years. AJCC regression scores were not independently prognostic within stage II cancers. However, AJCC scores were strongly associated with prognosis within stage III cancers (nonresponse 5-year overall survival [OS] 27% vs 67%, P < 0.001). Stage III responders (N = 139, 76.4%) had similar outcomes to stage II (5-year OS 67% vs 74%, P = 0.89). Conversely, stage III nonresponders (N = 43, 23.6%) approached stage IV outcomes (5-year OS 27% vs 18%, P = 0.09). On multivariable analysis, nonresponse (hazard ratio 3.2, 95% confidence interval 1.7-6.2), along with positive margin, abdominoperineal resection, and no adjuvant chemotherapy administration were independently associated with worse OS.
AJCC response score after nCRT is a novel prognostic factor in pathologic stage III rectal cancer and may guide surveillance and adjuvant therapy decisions.
评估美国癌症联合委员会（AJCC）肿瘤消退评分在病理 II 期和 III 期直肠癌中的独立预后能力。
新辅助放化疗（nCRT）后的反应一直被认为是直肠癌肿瘤生物学和预后的生物学替代物。AJCC 消退评分与预后相关。
从单机构接受 nCRT 治疗后行手术的 545 例直肠癌患者中评估患者人口统计学、肿瘤特征和 AJCC 评分（0=完全缓解；1=残留肿瘤细胞；2=纤维化中残留肿瘤生长；3=广泛残留肿瘤）。患者分为应答者（评分 0-2）或无应答者（评分 3）。使用 Cox 比例风险模型进行生存分析。
545 例患者中，123 例和 182 例分别为病理 II 期和 III 期。中位随访时间为 4.9 年。AJCC 消退评分在 II 期癌症中不能独立预测预后。然而，AJCC 评分与 III 期癌症的预后密切相关（无应答者 5 年总生存率[OS]为 27%，而 67%，P<0.001）。III 期应答者（N=139，76.4%）的结局与 II 期相似（5 年 OS 为 67%，74%，P=0.89）。相反，III 期无应答者（N=43，23.6%）接近 IV 期的结果（5 年 OS 为 27%，18%，P=0.09）。多变量分析显示，无应答（风险比 3.2，95%置信区间 1.7-6.2）、阳性切缘、腹会阴切除术和未行辅助化疗与较差的 OS 独立相关。
nCRT 后 AJCC 反应评分是病理 III 期直肠癌的一个新的预后因素，可能指导监测和辅助治疗决策。
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