Hepatobiliary Surgery and Liver Transplantation Department, Pitié Salpêtrière - APHP, Paris, France.
INSERM UMR S-938 (CRSA), Sorbonne Université, Paris, France.
Ann Surg Oncol. 2024 Jul;31(7):4436-4444. doi: 10.1245/s10434-024-15196-x. Epub 2024 Mar 28.
Optimal management of colorectal liver metastasis (CRLM) is based on a combination of chemotherapy and surgical resection. The tumor regression grade (TRG) score is a histological scoring system to evaluate response to chemotherapy. The prognosis of a heterogeneous response in cases of multiple metastases has not been evaluated according to the TRG score.
All patients who underwent liver resection for multiple CRLM after neoadjuvant chemotherapy in two tertiary centers from January 2015 to April 2019 were retrospectively included. Oncological characteristics and outcome between TRG 1-2-3 (good response group), TRG 4-5 (poor response group) and heterogeneous TRG (good and poor TRG among different lesions within the same patient) groups were compared.
Among the 327 patients included, 134 (41.0%) had good response (TRG 1-2-3), 120 (36.7%) had poor response (TRG 4-5), and 73 (22.3%) had heterogeneous response. The type and number of cycles of chemotherapy, k-Ras mutational status, and tumor number or size did not differ between the three groups. Use of irinotecan-based and anti-VEGF neoadjuvant therapy was associated with better TRG response [irinotecan-based: hazard ratio (OR) = 1.744; p = 0.045; anti-VEGF neoadjuvant therapy: 2.054; p = 0.005). Overall survival (OS) was higher in the 1-2-3 TRG group than in the heterogeneous TRG group (2-year OS = 81.3% vs. 60.3%, respectively; p = 0.003) and the 4-5 TRG group (2-year OS = 81.3% vs. 55.0%, respectively; p = 0.012) and similar between the heterogeneous and 4-5 TRG groups.
The proportion of heterogeneous pathological response according to TRG is 22.3%, and the prognosis is comparable to that of poor pathological response.
结直肠癌肝转移（CRLM）的最佳治疗方法是化疗联合手术切除。肿瘤退缩分级（TRG）评分是一种用于评估化疗反应的组织学评分系统。然而，对于多个转移灶的异质性反应，其预后尚未根据 TRG 评分进行评估。
本研究回顾性分析了 2015 年 1 月至 2019 年 4 月在两家三级中心接受新辅助化疗后行肝切除术的多发性 CRLM 患者。比较 TRG1-2-3（反应良好组）、TRG4-5（反应不良组）和异质性 TRG（同一患者不同病灶中存在良好和不良 TRG）组之间的肿瘤学特征和预后。
在纳入的 327 例患者中，134 例（41.0%）为良好反应（TRG1-2-3），120 例（36.7%）为不良反应（TRG4-5），73 例（22.3%）为异质性反应。三组患者的化疗类型和周期数、k-Ras 突变状态、肿瘤数量或大小无差异。伊立替康为基础和抗 VEGF 新辅助治疗与更好的 TRG 反应相关[伊立替康为基础：风险比（HR）=1.744；p=0.045；抗 VEGF 新辅助治疗：HR=2.054；p=0.005]。1-2-3TRG 组的总生存期（OS）高于异质性 TRG 组（2 年 OS 分别为 81.3%和 60.3%；p=0.003）和 4-5TRG 组（2 年 OS 分别为 81.3%和 55.0%；p=0.012），而异质性 TRG 组与 4-5TRG 组之间的 OS 无差异。
根据 TRG，异质性病理反应的比例为 22.3%，其预后与不良病理反应相当。
