Department of Pathology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
Gut Liver. 2022 Jan 15;16(1):129-137. doi: 10.5009/gnl20312.
BACKGROUND/AIMS: Neoadjuvant chemotherapy is increasingly utilized in patients with borderline or locally advanced pancreatic cancer (LAPC). However, the pathologic evaluation of tumor regression is not routinely performed or well established. We aimed to evaluate the prognostic value of three tumor regression grading systems frequently used in LAPC and to determine the correlation between pathologic and clinical response.
We included a total of 38 patients with LAPC who were treated with neoadjuvant chemotherapy and subsequent resection. Pathologic tumor regression was graded based on the College of American Pathologists (CAP), Evans, and MD Anderson grading systems.
One out of 38 patients (2.6%) achieved a pathologic complete response. Unlike other grading systems (Evans, p=0.063; MD Anderson, p=0.110), the CAP grading system was a significant prognostic factor for overall survival (p=0.043). Pathologic N stage (p=0.023), margin status (p=0.044), and radiologic response (p=0.016) correlated with overall survival. In the multivariate analysis, CAP 3 was an independent predictor of shorter overall survival (p=0.026). The CAP grading system correlated with the radiologic response (p=0.007) but not the carbohydrate antigen 19-9 level (p=0.333).
The four-tier CAP pathologic tumor regression grading system predicted the clinical outcome in LAPC patients who underwent resection after neoadjuvant chemotherapy. Therefore, a more comprehensive pathologic evaluation is warranted in these patients.
背景/目的：新辅助化疗在交界性或局部晚期胰腺癌（LAPC）患者中的应用越来越多。然而，肿瘤退缩的病理评估并未常规进行或尚未建立。我们旨在评估常用于 LAPC 的三种肿瘤消退分级系统的预后价值，并确定病理与临床反应之间的相关性。
我们共纳入 38 例接受新辅助化疗和随后切除的 LAPC 患者。根据美国病理学家学院（CAP）、Evans 和 MD 安德森分级系统对肿瘤进行病理分级。
38 例患者中仅有 1 例（2.6%）达到完全病理缓解。与其他分级系统（Evans，p=0.063；MD 安德森，p=0.110）不同，CAP 分级系统是总生存的显著预后因素（p=0.043）。病理 N 分期（p=0.023）、切缘状态（p=0.044）和影像学反应（p=0.016）与总生存相关。多因素分析显示，CAP3 是总生存较短的独立预测因素（p=0.026）。CAP 分级系统与影像学反应相关（p=0.007），但与癌抗原 19-9 水平无关（p=0.333）。
接受新辅助化疗后行切除术的 LAPC 患者，四分级 CAP 肿瘤消退病理分级系统预测了临床结局。因此，这些患者需要更全面的病理评估。
