Department of Gastric Surgery, Liaoning Cancer Hospital and Institute, Cancer Hospital of China Medical University, China.
Department of Pathology, Liaoning Cancer Hospital and Institute, Cancer Hospital of China Medical University, China.
Pathol Res Pract. 2020 Sep;216(9):153073. doi: 10.1016/j.prp.2020.153073. Epub 2020 Jun 20.
As the neoadjuvant therapy has been successfully introduced in the treatment of gastrointestinal malignancies, the evaluation of therapeutic effectiveness is becoming increasingly important. Tumor-node-metastasis system has been widely applied. However, this system is mainly based on the location of residual tumor, but does not consider the amount of residual tumor. Tumor regression grading system, a quantitative method to assess the reaction of tumor to neoadjuvant treatment, could be used as a supplement to tumor-node-metastasis system and provide additional information on prognosis. To date, numerous gastrointestinal grading systems have been used in esophageal/esophagogastric junction carcinoma, gastric adenocarcinoma, colorectal cancer, and most of them were considered to associate with clinical outcomes.
In this review, firstly, we expounded the importance of tumor regression grading systems, and summarized the histopathological changes after neoadjuvant therapy. Secondly, we introduced some commonly used gastrointestinal systems, as well as the relationships and nuance. Finally, we discussed pivotal issues about these systems. In this part, we explained the calculation methods based on grid points and square measures, discussed several factors leading to observer bias, containing the slice number and the grading tier number, and analyzed the factors that might affect clinical significance, covering anatomical location, the selection of survival index, and the tumor type.
Tumor regression grade systems could be divided into two main classifications, the relative amount of fibrosis and residual tumor, and the proportion of residual tumor in the tumor bed. However, the definitions of these systems were still need to be improved.
The tumor regression grading system is useful in evaluating tumor response to neoadjuvant therapy, but more work is needed to refine and unify the system.
随着新辅助疗法在胃肠道恶性肿瘤治疗中的成功引入，治疗效果的评估变得越来越重要。肿瘤-淋巴结-转移（TNM）系统得到了广泛应用。然而，该系统主要基于残留肿瘤的位置，而不考虑残留肿瘤的数量。肿瘤退缩分级系统是一种评估肿瘤对新辅助治疗反应的定量方法，可以作为 TNM 系统的补充，并提供预后的额外信息。迄今为止，许多胃肠道分级系统已用于食管/胃食管交界处癌、胃腺癌、结直肠癌，其中大多数被认为与临床结局相关。
在这篇综述中，首先我们阐述了肿瘤退缩分级系统的重要性，并总结了新辅助治疗后组织病理学的变化。其次，我们介绍了一些常用的胃肠道系统，并探讨了它们之间的关系和细微差别。最后，我们讨论了这些系统的关键问题。在这部分，我们解释了基于网格点和方格测量的计算方法，讨论了导致观察者偏倚的几个因素，包括切片数量和分级级别数量，并分析了可能影响临床意义的因素，包括解剖位置、生存指数的选择和肿瘤类型。
肿瘤退缩分级系统可分为两种主要分类，即纤维化和残留肿瘤的相对数量，以及肿瘤床中残留肿瘤的比例。然而，这些系统的定义仍需进一步完善。
肿瘤退缩分级系统在评估肿瘤对新辅助治疗的反应方面是有用的，但仍需要进一步细化和统一该系统。
