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食管癌术前放化疗后肿瘤消退的病理评估。临床病理相关性。

Pathologic assessment of tumor regression after preoperative chemoradiotherapy of esophageal carcinoma. Clinicopathologic correlations.

作者信息

Mandard A M, Dalibard F, Mandard J C, Marnay J, Henry-Amar M, Petiot J F, Roussel A, Jacob J H, Segol P, Samama G

机构信息

Department of Pathology, Centre François Baclesse, Caen, France.

出版信息

Cancer. 1994 Jun 1;73(11):2680-6. doi: 10.1002/1097-0142(19940601)73:11<2680::aid-cncr2820731105>3.0.co;2-c.

Abstract

BACKGROUND

The benefits of preoperative chemotherapy and radiation for esophageal carcinoma are under investigation. A pilot study was undertaken to determine if pathologic assessment of tumor regression correlated with disease free survival.

METHODS

Ninety-three resected specimens from patients treated with cis-dichloro-diamino cisplatin and irradiation before surgery were examined on semiserial sections. Patients selected for surgery were all Status 1 according to the World Health Organization (WHO) classification. Histologic typing was based on the WHO classification. Tumor regression grade (TRG) was quantitated in five grades: TRG 1 (complete regression) showed absence of residual cancer and fibrosis extending through the different layers of the esophageal wall; TRG 2 was characterized by the presence of rare residual cancer cells scattered through the fibrosis; TRG 3 was characterized by an increase in the number of residual cancer cells, but fibrosis still predominated; TRG 4 showed residual cancer outgrowing fibrosis; and TRG 5 was characterized by absence of regressive changes. Survival curves were estimated according to the Kaplan-Meier method. A quantification of the relationship between treatment failure and confounding variables (age, tumor location, tumor size, esophageal wall involvement by residual cancer and/or regressive changes, histology, treatment, adequacy of surgery, pathologic lymph node status, and tumor regression grade) was done using Cox's proportional hazards model.

RESULTS

Forty-two percent of specimens were TGR 1-2; 20%, TGR 3; and 33%, TGR 4-5. Univariate analysis found that tumor size, pathologic lymph node status, tumor regression grade, and esophageal wall involvement were highly correlated with disease free survival (P < 0.05). After multivariate analysis, only tumor regression (i.e., TRG 1-3 versus TRG 4-5) remained a significant (P < 0.001) predictor of disease free survival.

CONCLUSIONS

This study highlights the importance of tumor regression in the survival of patients with esophageal carcinoma treated with preoperative chemoradiotherapy. These findings suggest that tumor regression grade should be considered when evaluating therapeutic results.

摘要

背景

术前化疗和放疗对食管癌的益处正在研究中。开展了一项初步研究以确定肿瘤消退的病理评估是否与无病生存期相关。

方法

对93例术前接受顺铂和放疗治疗的患者的切除标本进行半连续切片检查。根据世界卫生组织(WHO)分类,入选手术的患者均为1级。组织学分类基于WHO分类。肿瘤消退分级(TRG)分为五个等级:TRG 1(完全消退)表现为无残留癌且纤维化延伸至食管壁各层;TRG 2的特征是在纤维化中散在分布着罕见的残留癌细胞;TRG 3的特征是残留癌细胞数量增加,但纤维化仍占主导;TRG 4表现为残留癌超过纤维化;TRG 5的特征是无消退改变。根据Kaplan-Meier方法估计生存曲线。使用Cox比例风险模型对治疗失败与混杂变量(年龄、肿瘤位置、肿瘤大小、残留癌和/或消退改变累及食管壁情况、组织学、治疗、手术充分性、病理淋巴结状态和肿瘤消退分级)之间的关系进行量化分析。

结果

42%的标本为TRG 1 - 2级;20%为TRG 3级;33%为TRG 4 - 5级。单因素分析发现肿瘤大小、病理淋巴结状态、肿瘤消退分级和食管壁受累情况与无病生存期高度相关(P < 0.05)。多因素分析后,只有肿瘤消退(即TRG 1 - 3级与TRG 4 - 5级)仍然是无病生存期的显著(P < 0.

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