Hemmings Chris, Connor Saxon
Department of Anatomic Pathology, Canterbury Health Laboratories, Christchurch Central, New Zealand; Department of Pathology and Biomedical Science, University of Otago Medical School, Christchurch Central, New Zealand.
Department of Surgery, Christchurch Hospital, Christchurch Central, New Zealand.
Pathology. 2020 Oct;52(6):621-626. doi: 10.1016/j.pathol.2020.07.001. Epub 2020 Aug 13.
Pancreatic carcinoma is a relatively common malignancy with an overall poor prognosis which is somewhat improved in those patients for whom resection and adjuvant therapy is feasible. In recent years there has been a trend to administering neoadjuvant therapy (combination chemotherapy and/or chemoradiotherapy), followed by resection in patients who remain surgical candidates at the completion of this treatment. Advantages of a neoadjuvant approach may include greater likelihood of achieving complete resection with negative surgical margins, reduced treatment toxicity and greater cost effectiveness, as well as potentially sparing patients with rapidly progressive disease from major surgery. To gauge the tumour's response to preoperative therapy, and to compare the efficacy of different regimens, there is a need for a robust and reproducible system of assessing tumour regression in resection specimens. Several such systems have been proposed, but there is generally a lack of consensus as to which system is the 'best'. This review describes the evolution of a number of tumour regression grading systems which have been proposed, and discusses the relative merits and shortfalls of several of the most frequently applied schemata. Some problems common to many of these include poorly defined criteria, low interobserver reproducibility and a reliance on fibrosis as a surrogate for tumour kill, which may not be valid. Despite that, recent evidence suggests that the Dworak grading system (first developed for rectal cancer) may be useful in terms of both interobserver concordance and correlation with survival.
胰腺癌是一种相对常见的恶性肿瘤，总体预后较差，不过对于那些可行手术切除及辅助治疗的患者，预后会有所改善。近年来，有一种趋势是先给予新辅助治疗（联合化疗和/或放化疗），然后对在该治疗结束时仍适合手术的患者进行手术切除。新辅助治疗方法的优点可能包括更有可能实现切缘阴性的完整切除、降低治疗毒性和提高成本效益，以及有可能使患有快速进展性疾病的患者免于大手术。为了评估肿瘤对术前治疗的反应，并比较不同方案的疗效，需要一个强大且可重复的系统来评估切除标本中的肿瘤退缩情况。已经提出了几种这样的系统，但对于哪种系统是“最佳”系统，通常缺乏共识。本综述描述了已提出的一些肿瘤退缩分级系统的演变，并讨论了几种最常用方案的相对优点和不足。其中许多系统共有的一些问题包括标准定义不明确、观察者间再现性低以及依赖纤维化作为肿瘤杀伤的替代指标，而这可能并不有效。尽管如此，最近的证据表明，德沃拉克分级系统（最初为直肠癌开发）在观察者间一致性和与生存率的相关性方面可能是有用的。
