Chen Hai-Yang, Feng Li-Li, Li Ming, Ju Huai-Qiang, Ding Yi, Lan Mei, Song Shu-Mei, Han Wei-Dong, Yu Li, Wei Ming-Biao, Pang Xiao-Lin, He Fang, Liu Shuai, Zheng Jian, Ma Yan, Lin Chu-Yang, Lan Ping, Huang Mei-Jin, Zou Yi-Feng, Yang Zu-Li, Wang Ting, Lang Jin-Yi, Orangio Guy R, Poylin Vitaliy, Ajani Jaffer A, Wang Wei-Hu, Wan Xiang-Bo
Department of Radiation Oncology, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China.
Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangdong Institute of Gastroenterology, Guangzhou, People's Republic of China.
Oncologist. 2021 May;26(5):e780-e793. doi: 10.1002/onco.13707. Epub 2021 Feb 22.
The National Comprehensive Cancer Network's Rectal Cancer Guideline Panel recommends American Joint Committee of Cancer and College of American Pathologists (AJCC/CAP) tumor regression grading (TRG) system to evaluate pathologic response to neoadjuvant chemoradiotherapy for locally advanced rectal cancer (LARC). Yet, the clinical significance of the AJCC/CAP TRG system has not been fully defined.
This was a multicenter, retrospectively recruited, and prospectively maintained cohort study. Patients with LARC from one institution formed the discovery set, and cases from external independent institutions formed a validation set to verify the findings from discovery set. Overall survival (OS), disease-free survival (DFS), local recurrence-free survival (LRFS), and distant metastasis-free survival (DMFS) were assessed by Kaplan-Meier analysis, log-rank test, and Cox regression model.
The discovery set (940 cases) found, and the validation set (2,156 cases) further confirmed, that inferior AJCC/CAP TRG categories were closely /ccorrelated with unfavorable survival (OS, DFS, LRFS, and DMFS) and higher risk of disease progression (death, accumulative relapse, local recurrence, and distant metastasis) (all p < .05). Significantly, pairwise comparison revealed that any two of four TRG categories had the distinguished survival and risk of disease progression. After propensity score matching, AJCC/CAP TRG0 category (pathological complete response) patients treated with or without adjuvant chemotherapy displayed similar survival of OS, DFS, LRFS, and DMFS (all p > .05). For AJCC/CAP TRG1-3 cases, adjuvant chemotherapy treatment significantly improved 3-year OS (90.2% vs. 84.6%, p < .001). Multivariate analysis demonstrated the AJCC/CAP TRG system was an independent prognostic surrogate.
AJCC/CAP TRG system, an accurate prognostic surrogate, appears ideal for further strategizing adjuvant chemotherapy for LARC.
The National Comprehensive Cancer Network recommends the American Joint Committee of Cancer and College of American Pathologists (AJCC/CAP) tumor regression grading (TRG) four-category system to evaluate the pathologic response to neoadjuvant treatment for patients with locally advanced rectal cancer; however, the clinical significance of the AJCC/CAP TRG system has not yet been clearly addressed. This study found, for the first time, that any two of four AJCC/CAP TRG categories had the distinguished long-term survival outcome. Importantly, adjuvant chemotherapy may improve the 3-year overall survival for AJCC/CAP TRG1-3 category patients but not for AJCC/CAP TRG0 category patients. Thus, AJCC/CAP TRG system, an accurate surrogate of long-term survival outcome, is useful in guiding adjuvant chemotherapy management for rectal cancer.
美国国立综合癌症网络直肠癌指南小组推荐采用美国癌症联合委员会和美国病理学家学会（AJCC/CAP）的肿瘤退缩分级（TRG）系统来评估局部晚期直肠癌（LARC）新辅助放化疗后的病理反应。然而，AJCC/CAP TRG系统的临床意义尚未完全明确。
这是一项多中心、回顾性招募和前瞻性维持的队列研究。来自一个机构的LARC患者构成发现集，来自外部独立机构的病例构成验证集，以验证发现集的结果。通过Kaplan-Meier分析、对数秩检验和Cox回归模型评估总生存期（OS）、无病生存期（DFS）、无局部复发生存期（LRFS）和无远处转移生存期（DMFS）。
发现集（940例）发现，验证集（2156例）进一步证实，较低级别的AJCC/CAP TRG类别与不良生存（OS、DFS、LRFS和DMFS）以及疾病进展（死亡、累积复发、局部复发和远处转移）的较高风险密切相关（所有p < 0.05）。值得注意的是，两两比较显示，四个TRG类别中的任意两个在生存和疾病进展风险方面都有显著差异。倾向评分匹配后，接受或未接受辅助化疗的AJCC/CAP TRG0类别（病理完全缓解）患者在OS、DFS、LRFS和DMFS方面显示出相似的生存情况（所有p > 0.05）。对于AJCC/CAP TRG1-3病例，辅助化疗显著提高了3年OS（90.2%对84.6%，p < 0.001）。多变量分析表明AJCC/CAP TRG系统是一个独立的预后替代指标。
AJCC/CAP TRG系统是一个准确的预后替代指标，似乎是为LARC进一步制定辅助化疗策略的理想选择。
美国国立综合癌症网络推荐美国癌症联合委员会和美国病理学家学会（AJCC/CAP）的肿瘤退缩分级（TRG）四类系统来评估局部晚期直肠癌患者新辅助治疗后的病理反应；然而，AJCC/CAP TRG系统的临床意义尚未得到明确阐述。本研究首次发现，AJCC/CAP四个TRG类别中的任意两个在长期生存结果方面都有显著差异。重要的是，辅助化疗可能改善AJCC/CAP TRG1-3类别患者的3年总生存期，但对AJCC/CAP TRG０类别患者无效。因此，AJCC/CAP TRG系统作为长期生存结果的准确替代指标，有助于指导直肠癌的辅助化疗管理。
