Picci P, Rougraff B T, Bacci G, Neff J R, Sangiorgi L, Cazzola A, Baldini N, Ferrari S, Mercuri M, Ruggieri P
Laboratory for Oncologic Research, Rizzoli Orthopaedic Institute, Bologna, Italy.
J Clin Oncol. 1993 Sep;11(9):1763-9. doi: 10.1200/JCO.1993.11.9.1763.
To evaluate more accurately the effectiveness of preoperative chemotherapy in the treatment of patients with Ewing's sarcoma, we studied histopathologically the chemotherapeutic response and correlated it to oncologic outcome.
Between June 1983 and December 1989, 68 patients with nonmetastatic Ewing's sarcoma of the extremities were treated at our institute with preoperative chemotherapy (without radiation therapy) and surgery. The specimens were retrospectively evaluated for areas of viable tumor cells and graded from I to III (macroscopic, microscopic, or no residual disease, respectively) in a blinded fashion. Clinical follow-up data were available on all patients for a mean of 60 months (range, 32 to 111).
This histopathologic analysis was strongly correlated with oncologic outcome (P = .004). Patients who demonstrated grade III response (no identifiable viable tumor nodules present) had improved 5-year disease-free survival rates as compared with patients with grade II (microscopic nodes present; P = .023; 90% v 53%) and grade I responses (macroscopic nodules present; P = .0003; 90% v 32%). Patients with grade II necrosis had statistically improved survival rates over those with grade I necrosis (53% v 32%; P = .074).
This new histopathologic analysis technique for the evaluation of neoadjuvant chemotherapy effectiveness (which does not rely on tumor volume for its assessment) is a valuable prognostic indicator for patients with Ewing's sarcoma treated with surgery. Based on this preliminary report, cases of grade I or II chemotherapeutic tumor response should be considered clinical failures and a different, more aggressive postoperative chemotherapy regimen should be considered.
为了更准确地评估术前化疗在尤因肉瘤患者治疗中的有效性，我们对化疗反应进行了组织病理学研究，并将其与肿瘤学结局相关联。
1983年6月至1989年12月期间，我院对68例四肢非转移性尤因肉瘤患者进行了术前化疗（不进行放疗）及手术治疗。对标本进行回顾性评估，以确定存活肿瘤细胞区域，并以盲法从I级到III级进行分级（分别为宏观、微观或无残留疾病）。所有患者均有平均60个月（范围32至111个月）的临床随访数据。
这种组织病理学分析与肿瘤学结局密切相关（P = 0.004）。与II级反应（存在微观结节；P = 0.023；90%对53%）和I级反应（存在宏观结节；P = 0.0003；90%对32%）的患者相比，表现为III级反应（不存在可识别的存活肿瘤结节）的患者5年无病生存率更高。II级坏死的患者生存率在统计学上高于I级坏死的患者（53%对32%；P = 0.074）。
这种用于评估新辅助化疗有效性的新组织病理学分析技术（其评估不依赖于肿瘤体积）是接受手术治疗的尤因肉瘤患者的一个有价值的预后指标。基于本初步报告，I级或II级化疗肿瘤反应的病例应被视为临床失败，应考虑采用不同的、更积极的术后化疗方案。
