局部进展期胃腺癌中 Mandard 和 Becker 肿瘤退缩分级预测价值的评估与比较。

Evaluation and Comparison of Predictive Value of Tumor Regression Grades according to Mandard and Becker in Locally Advanced Gastric Adenocarcinoma.

机构信息

Department of Gastric Surgery, Liaoning Cancer Hospital and Institute, Cancer Hospital of China Medical University, Shenyang, China.

Department of Pathology, Liaoning Cancer Hospital and Institute, Cancer Hospital of China Medical University, Shenyang, China.

出版信息

Cancer Res Treat. 2021 Jan;53(1):112-122. doi: 10.4143/crt.2020.516. Epub 2020 Aug 10.

PURPOSE

Tumor regression grade (TRG) has been widely used in gastrointestinal carcinoma to assess pathological responses to neoadjuvant chemotherapy (NCT). There are various standards without a consensus, and it is still unclear which kind of system has better predictive value. This study aims to investigate and compare the predictive ability of the Mandard and Becker TRGs in patients with locally advanced gastric cancer.

MATERIALS AND METHODS

A total of 290 patients with locally advanced gastric adenocarcinoma who underwent NCT and curative surgery were studied. Survival analysis for overall survival (OS) and disease-free survival (DFS) were based on the Kaplan-Meier method and Cox proportional hazards method. Predictive values of TRGs and models were assessed by time-dependent receiver operating characteristic (ROC) curve, the area under the ROC curve (AUC), nomogram, and calibration curve.

RESULTS

In multivariable analysis, the Mandard TRG was associated with OS (hazard ratio [HR], 1.806; p=0.026) and DFS (HR, 1.792; p=0.017). The Becker TRG was also related to OS (HR, 1.880; p=0.014) and DFS (HR, 1.919; p=0.006). The Mandard and Becker TRG AUCs for 5-year survival were 0.72 and 0.71, respectively. The whole models showed an increased predictive value, with AUCs of 0.85 and 0.86, respectively. There was no significant difference between the two TRGs and two models.

CONCLUSION

TRG was an independent predictor for survival, and there was no significant difference between these two systems.

目的

肿瘤退缩分级（TRG）已广泛用于胃肠道癌，以评估新辅助化疗（NCT）后的病理反应。目前有多种标准但尚无共识，尚不清楚哪种系统具有更好的预测价值。本研究旨在探讨和比较曼达德（Mandard）和贝克尔（Becker）TRG 系统在局部进展期胃癌患者中的预测能力。

材料和方法

共纳入 290 例接受 NCT 和根治性手术的局部进展期胃腺癌患者。采用 Kaplan-Meier 法和 Cox 比例风险模型进行总生存（OS）和无病生存（DFS）的生存分析。通过时间依赖性接受者操作特征（ROC）曲线、ROC 曲线下面积（AUC）、列线图和校准曲线评估 TRG 和模型的预测价值。

结果

多变量分析显示，曼达德 TRG 与 OS（风险比 [HR]，1.806；p=0.026）和 DFS（HR，1.792；p=0.017）相关。贝克尔 TRG 也与 OS（HR，1.880；p=0.014）和 DFS（HR，1.919；p=0.006）相关。曼达德和贝克尔 TRG 预测 5 年生存率的 AUC 分别为 0.72 和 0.71。整体模型显示出更高的预测价值，AUC 分别为 0.85 和 0.86。两种 TRG 和两种模型之间无显著差异。