Scaglione Giulia, Arciuolo Damiano, Travaglino Antonio, Santoro Angela, Angelico Giuseppe, Spadola Saveria, Inzani Frediano, D'Alessandris Nicoletta, Raffone Antonio, Fulgione Caterina, Padial Urtueta Belen, Sfregola Stefania, Valente Michele, Addante Francesca, d'Amati Antonio, Cianfrini Federica, Piermattei Alessia, Pedone Anchora Luigi, Scambia Giovanni, Ferrandina Gabriella, Zannoni Gian Franco
Gynecopathology and Breast Pathology Unit, Department of Woman and Child's Health and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy.
Pathology Unit, Department of Medicine and Technological Innovation, University of Insubria, 21100 Varese, Italy.
Diagnostics (Basel). 2023 Oct 17;13(20):3228. doi: 10.3390/diagnostics13203228.
In locally advanced cervical cancer (LACC), definitive chemo-radiotherapy is the standard treatment, but chemo-radiotherapy followed by surgery could be an alternative choice in selected patients. We enrolled 244 patients affected by LACC and treated with CT-RT followed by surgery in order to assess the prognostic role of the histological response using the Mandard scoring system. Results: A complete pathological response (TRG 0) was observed in 118 patients (48.4%), rare residual cancer cells (TRG2) were found in 49 cases (20.1%), increased number of cancer cells but fibrosis still predominating (TRG3) in 35 cases (14.3%), and 42 (17.2%) were classified as non-responders (TRG4-5). TRG was significantly associated with both OS ( < 0.001) and PFS ( < 0.001). The survival curves highlighted two main prognostic groups: TRG1-TRG2 and TRG3-TRG4-5. Main responders (TRG1-2) showed a 92% 5-year overall survival (5y-OS) and a 75% 5-year disease free survival (5y-DFS). Minor or no responders showed a 48% 5y-OS and a 39% 5y-DFS. The two-tiered TRG was independently associated with both DFS and OS in Cox regression analysis. Conclusion. We showed that Mandard TRG is an independent prognostic factor in post-CT/RT LACC, with potential benefits in defining post-treatment adjuvant therapy.
在局部晚期宫颈癌（LACC）中，根治性放化疗是标准治疗方法，但对于部分特定患者，放化疗后行手术可能是一种替代选择。我们纳入了244例LACC患者，对其进行放化疗后手术治疗，以使用曼德尔评分系统评估组织学反应的预后作用。结果：118例患者（48.4%）观察到完全病理缓解（TRG 0），49例（20.1%）发现罕见残留癌细胞（TRG2），35例（14.3%）癌细胞数量增加但纤维化仍占主导（TRG3），42例（17.2%）被归类为无反应者（TRG4 - 5）。TRG与总生存期（OS，<0.001）和无进展生存期（PFS，<0.001）均显著相关。生存曲线突出显示了两个主要预后组：TRG1 - TRG2和TRG3 - TRG4 - 5。主要反应者（TRG1 - 2）的5年总生存率（5y - OS）为92%，5年无病生存率（5y - DFS）为75%。次要反应者或无反应者的5y - OS为48%，5y - DFS为39%。在Cox回归分析中，两级TRG与DFS和OS均独立相关。结论。我们表明，曼德尔TRG是放化疗后LACC的独立预后因素，在确定治疗后辅助治疗方面具有潜在益处。
