一种新的肿瘤分期系统，将肿瘤退缩分级（TRG）与淋巴结状态（ypN 分类）相结合，比新辅助治疗后食管鳞癌的 ypTNM 分期组具有更好的预后预测价值。
A Novel Tumor Staging System Incorporating Tumor Regression Grade (TRG) With Lymph Node Status (ypN-Category) Results in Better Prognostication Than ypTNM Stage Groups After Neoadjuvant Therapy for Esophageal Squamous Cell Carcinoma.
机构信息
Department of Surgery, School of Clinical Medicine, The University of Hong Kong, Hong Kong SAR, China.
Division of Thoracic Surgery, Chang Gung Memorial Hospital-Linkou, Chang Gung University, Taoyuan, Taiwan.
出版信息
Ann Surg. 2022 Nov 1;276(5):784-791. doi: 10.1097/SLA.0000000000005636. Epub 2022 Jul 25.
OBJECTIVE
This study aims at constructing a staging system incorporating tumor regression grade and ypN-category (TRG-N) in patients with neoadjuvant therapy before esophagectomy. It is hypothesized that this would prognosticate better than the current American Joint Committee on Cancer (AJCC) postneoadjuvant therapy (ypTNM) stage groups.
BACKGROUND
Conventional pathological T-category is defined by the depth of invasion, and may lose prognostic relevance after neoadjuvant therapy. TRG defines treatment response by the degree of tumor regression, and when combined with ypN-category may be more prognostic than AJCC postneoadjuvant therapy (ypTNM) stage groups.
METHODS
A training cohort of 210 patients with esophageal squamous cell carcinoma and who had had neoadjuvant therapy before esophagectomy were studied. A validation cohort comprised 107 patients from another hospital. Resected esophagi were assessed by ypT-category and TRG, the latter assigned according to the Becker 4-tier system. These categories were grouped with ypN-category into a TRG-N system. Patients' survival was compared between the current AJCC postneoadjuvant therapy (ypTNM) stage groups and this TRG-N system.
RESULTS
In the training cohort, 5-year survival rates according to ypTNM stage I, II, IIIA, IIIB, and IVA were 53%, 39.4%, 47%, 18.3%, and 0%, respectively. For TRG-N stages I, II, III, and IV, the respective figures were 59.6%, 43.5%, 23.8%, and 15.6%. TRG-N stage showed better fit in survival than ypTNM stage groups, indicated by lower Akaike Information Criteria (AIC) and Bayesian Information Criterion values. Similar results were found in the validation cohort. Multivariate analysis showed that TRG-N stage ( P =0.02), age ( P =0.006), and sex ( P =0.005) were independent prognostic factors.
CONCLUSION
TRG-N stage shows better prognostication than the AJCC postneoadjuvant therapy (ypTNM) stage groups.
目的
本研究旨在构建一个包含肿瘤退缩分级和 ypN 分期（TRG-N）的新辅助治疗前食管癌分期系统。假设这比目前的美国癌症联合委员会（AJCC）新辅助治疗后（ypTNM）分期组更能预测预后。
背景
传统的病理学 T 分期是根据浸润深度定义的，新辅助治疗后可能失去预后相关性。TRG 通过肿瘤退缩程度定义治疗反应，当与 ypN 分期结合时，可能比 AJCC 新辅助治疗后（ypTNM）分期组更具有预后意义。
方法
研究了 210 例接受新辅助治疗前食管鳞癌切除术的患者组成的训练队列和来自另一家医院的 107 例验证队列。通过 ypT 分期和 TRG 评估切除的食管，后者根据 Becker 4 级系统进行分级。这些类别与 ypN 分期一起分为 TRG-N 系统。比较当前 AJCC 新辅助治疗后（ypTNM）分期组和该 TRG-N 系统之间患者的生存情况。
结果
在训练队列中，根据 ypTNM 分期 I、II、IIIA、IIIB 和 IVA，5 年生存率分别为 53%、39.4%、47%、18.3%和 0%。对于 TRG-N 分期 I、II、III 和 IV，相应的数字分别为 59.6%、43.5%、23.8%和 15.6%。TRG-N 分期在生存方面的拟合效果优于 ypTNM 分期组，表现为较低的赤池信息量准则（AIC）和贝叶斯信息准则值。验证队列中也得到了类似的结果。多变量分析显示，TRG-N 分期（P=0.02）、年龄（P=0.006）和性别（P=0.005）是独立的预后因素。
结论
TRG-N 分期比 AJCC 新辅助治疗后（ypTNM）分期组具有更好的预后预测能力。
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