肿瘤退缩分级对术前放化疗治疗的局部晚期直肠癌长期生存的影响。

The impact of tumor regression grade on long-term survival in locally advanced rectal cancer treated with preoperative chemoradiotherapy.

作者信息

Sakin Abdullah, Sahin Suleyman, Sengul Samanci Nilay, Yasar Nurgul, Demir Cumhur, Geredeli Caglayan, Erhan Selma Sengiz, Akboru Mustafa Halil, Cihan Sener

机构信息

Department of Medical Oncology, Yuzuncu Yil University Faculty of Medicine, Van, Turkey.

Department of Medical Oncology, University of Health Sciences, Van Training and Research hospital, Van, Turkey.

出版信息

J Oncol Pharm Pract. 2020 Oct;26(7):1611-1620. doi: 10.1177/1078155219900944. Epub 2020 Feb 11.

DOI:10.1177/1078155219900944

PMID:32046577

Abstract

PURPOSE

The aim of this study is to investigate the prognostic effect of tumor regression grade (TRG) on long-term survival in locally advanced rectal cancer treated with preoperative chemoradiotherapy.

METHODS

Medical records of 182 patients with locally advanced rectal cancer, who were treated with preoperative chemoradiotherapy followed by surgery between 2002 and 2016, were retrospectively reviewed. TRG was classified into five categories based on the pathological response as follows - TRG1: no viable cancer cell, TRG2: single cancer cell or small groups of cancer cells, TRG3: residual tumor outgrown by fibrosis, TRG4: residual tumor outgrowing fibrosis, TRG5: diffuse residual tumor without regression. TRG1, (TRG2+TRG3), and (TRG4+TRG5) were grouped as complete response, intermediate response, and no response, respectively.

RESULTS

Of the 182 patients with locally advanced rectal cancer, 112 (61.5%) were male. The mean age was 54.4 (range, 25-87) years. The total number of patients in complete response, intermediate response, and no response group was 24 (13.2%), 105 (57.7%), and 53 (29.1%), respectively. The corresponding five-year relapse-free survival and overall survival rates were 79.8%-92.3%, 74.7%-79.4%, and 55.7%-55.8%, respectively (p < 0.05 for relapse-free survival, p < 0.05 for overall survival). According to ypTNM stage, there was no significant difference in relapse-free survival among TRG groups in ypStage I and II patients (p > 0.05). In ypStage III patients, relapse-free survival was 62 months in no response group vs. not reached in intermediate response group (p < 0.05). According to the ypTNM, there was no significant difference in overall survival among TRG groups in ypStage I, II, and III patients (p > 0.05). In the multivariate analysis, pathological complete response was found to be an independent variable for relapse-free survival and overall survival (hazard ratio (95% confidence interval), 0.34 (0.17-6.77), 0.39 (0.18-0.83), respectively).

CONCLUSION

This study showed that patients with pathological complete response to preoperative chemoradiotherapy had longer relapse-free survival and overall survival rates than those with residual disease.

摘要

目的

本研究旨在探讨肿瘤退缩分级（TRG）对接受术前放化疗的局部晚期直肠癌患者长期生存的预后影响。

方法

回顾性分析2002年至2016年间182例接受术前放化疗后手术的局部晚期直肠癌患者的病历。根据病理反应将TRG分为五类，如下所示：TRG1：无存活癌细胞；TRG2：单个癌细胞或小群癌细胞；TRG3：残留肿瘤被纤维组织包绕；TRG4：残留肿瘤超过纤维组织；TRG5：弥漫性残留肿瘤无退缩。TRG1、（TRG2 + TRG3）和（TRG4 + TRG5）分别被归为完全缓解、中度缓解和无缓解组。

结果

182例局部晚期直肠癌患者中，112例（61.5%）为男性。平均年龄为54.4岁（范围25 - 87岁）。完全缓解组、中度缓解组和无缓解组的患者总数分别为24例（13.2%）、105例（57.7%）和53例（29.1%）。相应的五年无复发生存率和总生存率分别为79.8% - 92.3%、74.7% - 79.4%和55.7% - 55.8%（无复发生存率p < 0.05，总生存率p < 0.05）。根据ypTNM分期，ypI期和II期患者的TRG组间无复发生存率无显著差异（p > 0.05）。在ypIII期患者中，无缓解组的无复发生存期为62个月，中度缓解组未达到（p < 0.05）。根据ypTNM分期，ypI期、II期和III期患者的TRG组间总生存率无显著差异（p > 0.05）。多因素分析发现，病理完全缓解是无复发生存率和总生存率的独立变量（风险比（95%置信区间）分别为0.34（0.17 - 6.77）、0.39（0.18 - 0.83））。