Tang Yuan-Ling, Zhou Ji-Tao, Gu Xia-Fei, Yang Li-Juan, Li Dan-Dan, Duan Jia-Yu, Jiang Dan, Wang Xin
Department of Abdominal Cancer, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, P. R. China.
Department of Radiation Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, P. R. China.
Gastroenterol Rep (Oxf). 2024 May 30;12:goae050. doi: 10.1093/gastro/goae050. eCollection 2024.
Tumor regression grade (TRG) is evaluated by calculating the proportion of residual tumor to stromal fibrosis, which can reflect the tumor response to neoadjuvant chemoradiotherapy (NCRT) in patients with locally advanced rectal cancer (LARC). Overall, patients with TRG1 show good sensitivity to NCRT but the long-term survival for these patients remains different. This study aimed to assess the prognostic factors in patients with TRG1.
LARC patients who underwent NCRT and radical surgery were included. TRG was evaluated according to the National Comprehensive Cancer Network guidelines. The association between clinicopathological factors and survival outcomes was assessed in patients with TRG1. Overall survival (OS) and disease-free survival (DFS) were evaluated using both Kaplan-Meier analyses and Cox proportional hazards models.
Of the 393 LARC patients, 104 (26.5%) were diagnosed with TRG1. The 5-year OS rates and 5-year DFS rates of patients with TRG1 were 90.9% and 72.2%, respectively. In patients with TRG1, the tumor regression pattern (=0.001), pathologic tumor node metastasis (TNM) stage (=0.002), neoadjuvant rectal score (=0.024), T downstaging (=0.022), and baseline carcinoembryonic antigen level (=0.038) were associated with DFS in univariate analysis. Only the tumor regression pattern showed prognostic significance for DFS in multivariate analysis (=0.003). The group with tumor shrinkage had a higher OS rate than the tumor fragmentation group but the difference in the OS rates between the two groups was not significant (=0.196).
TRG could be a prognostic variable for LARC patients receiving NCRT. In patients with TRG1, the tumor regression pattern may represent another useful prognostic factor to better individualize the prognosis.
肿瘤退缩分级（TRG）通过计算残余肿瘤与间质纤维化的比例来评估，其可反映局部晚期直肠癌（LARC）患者对新辅助放化疗（NCRT）的肿瘤反应。总体而言，TRG1患者对NCRT显示出良好的敏感性，但这些患者的长期生存情况仍存在差异。本研究旨在评估TRG1患者的预后因素。
纳入接受NCRT和根治性手术的LARC患者。根据美国国立综合癌症网络指南评估TRG。对TRG1患者评估临床病理因素与生存结局之间的关联。采用Kaplan-Meier分析和Cox比例风险模型评估总生存期（OS）和无病生存期（DFS）。
在393例LARC患者中，104例（26.5%）被诊断为TRG1。TRG1患者的5年OS率和5年DFS率分别为90.9%和72.2%。在TRG1患者中，单因素分析显示肿瘤退缩模式（=0.001）、病理肿瘤淋巴结转移（TNM）分期（=0.002）、新辅助直肠评分（=0.024）、T分期下降（=0.022）和基线癌胚抗原水平（=0.038）与DFS相关。多因素分析中仅肿瘤退缩模式对DFS具有预后意义（=0.003）。肿瘤缩小组的OS率高于肿瘤碎片化组，但两组OS率的差异无统计学意义（=0.196）。
TRG可能是接受NCRT的LARC患者的一个预后变量。在TRG1患者中，肿瘤退缩模式可能是另一个有用的预后因素，可更好地实现预后个体化。
