新辅助治疗后胰腺导管腺癌切除术后残余肿瘤区（ART）的可重复性和预后意义。

Reproducibility and prognostic significance of area of residual tumor (ART) in post-neoadjuvant resections of pancreatic ductal adenocarcinoma.

机构信息

Oncology Pathology, Faculty of Medicine, Kagawa University, Japan.

Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, Japan.

出版信息

Pancreatology. 2021 Dec;21(8):1506-1515. doi: 10.1016/j.pan.2021.09.006. Epub 2021 Sep 10.

DOI:10.1016/j.pan.2021.09.006

PMID:34563448

Abstract

BACKGROUND

The pathologic assessments of tumor response after neoadjuvant chemoradiotherapy (NACRT) are critical to improving the prognostic stratification for patients with pancreatic ductal adenocarcinoma (PDAC). Here we clarified the utility of our new grading system based on the area of residual tumor (ART) as compared to existing systems, such as the College of American Pathologists (CAP) and MD Anderson (MDA) score.

METHODS

Eight reviewers individually evaluated the tumor regression grade of 30 patients with PDAC based on three types of grading systems. The interobserver concordance and clinicopathological characteristics were compared between the three systems.

RESULTS

The interobserver concordance (kappa value) of the ART, CAP, and MDA score were 0.61, 0.48, and 0.53, respectively. Discrepant cases, which were 27% of the cases, exhibited smaller tumor and tumor bed sizes than concordant cases. The reduction in tumor size evaluated by microscopy showed a correlation with the rate of change in carcinoembryonic antigen (CEA) level, CA19-9 level, and tumor size on computed tomography (CT). The ART score was correlated with the tumor size on CT before and after NACRT and disease-free survival. The CAP and MDA scores were not associated with prognosis.

CONCLUSION

The ART grading system may be the most practical system to assess the tumor response in post-NACRT resections of PDAC.

摘要

背景

新辅助放化疗（NACRT）后肿瘤反应的病理评估对于改善胰腺导管腺癌（PDAC）患者的预后分层至关重要。在这里，我们通过与现有系统（如美国病理学家学院（CAP）和 MD 安德森（MDA）评分）比较，明确了我们基于残余肿瘤面积（ART）的新分级系统的实用性。

方法

8 位审阅者分别根据三种分级系统评估了 30 例 PDAC 患者的肿瘤消退分级。比较了三种系统之间的观察者间一致性和临床病理特征。

结果

ART、CAP 和 MDA 评分的观察者间一致性（kappa 值）分别为 0.61、0.48 和 0.53。不一致的病例占病例的 27%，其肿瘤和肿瘤床的大小均小于一致的病例。显微镜下评估的肿瘤大小减少与癌胚抗原（CEA）水平、CA19-9 水平和 CT 上肿瘤大小的变化率相关。ART 评分与 NACRT 前后 CT 上的肿瘤大小和无病生存率相关。CAP 和 MDA 评分与预后无关。