Validation of a Proposed Tumor Regression Grading Scheme for Pancreatic Ductal Adenocarcinoma After Neoadjuvant Therapy as a Prognostic Indicator for Survival.
Validation of a Proposed Tumor Regression Grading Scheme for Pancreatic Ductal Adenocarcinoma After Neoadjuvant Therapy as a Prognostic Indicator for Survival.
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DOI：
10.1097/pas.0000000000000738
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发表时间：
2016-12
期刊：
影响因子：
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通讯作者：
Wang H
中科院分区：
文献类型：
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作者：
Lee SM;Katz MH;Liu L;Sundar M;Wang H;Varadhachary GR;Wolff RA;Lee JE;Maitra A;Fleming JB;Rashid A;Wang H
新辅助治疗已越来越多地用于治疗可能可切除的胰腺导管腺癌（PDAC）患者。尽管美国病理学家学会（CAP）已使用治疗后标本中肿瘤缓解的分级方案，但其临床意义尚未得到验证。以前，我们提出了一个三级组织学肿瘤消退分级（HTRG）方案（HTRG 0，无存活肿瘤; HTRG 1，< 5%存活肿瘤细胞; HTRG 2，≥ 5%存活肿瘤细胞），并表明三级HTRG方案与预后相关。在这项研究中，我们试图验证我们提出的HTRG方案在一个新的队列167个连续的PDAC患者谁完成新辅助治疗和胰腺切除术。我们发现HTRG 0或1的患者与HTRG 2的患者相比，淋巴结转移（p=0.004）和复发（p=0.01）的频率较低，ypT（p <0.001）和AJCC分期（p <0.001）较低，无病生存期（DFS，p=0.004）和总生存期（OS，p=0.02）较长。CAP 2级组与CAP 3级组的DFS和OS无显著性差异（p >0.05）。在多变量分析中，HTRG 0级或1级是较好DFS的独立预后因素（p =0.03），但不是OS。因此，我们验证了我们以前研究中提出的HTRG方案。拟议的HTRG方案简单易行，易于病理学家在实践中应用，并可用作完成新辅助治疗和手术的潜在可切除PDAC患者的长期DFS的成功替代品。
Neoadjuvant therapy has been increasingly used to treat patients with potentially resectable pancreatic ductal adenocarcinoma (PDAC). Although the College of American Pathologists (CAP) grading scheme for tumor response in post-therapy specimens has been used, its clinical significance has not been validated. Previously, we proposed a three-tier histologic tumor regression grading (HTRG) scheme (HTRG 0, no viable tumor; HTRG 1, < 5% viable tumor cells; HTRG 2, ≥5 % viable tumor cells) and showed that the three-tier HTRG scheme correlated with prognosis. In this study, we sought to validate our proposed HTRG scheme in a new cohort of 167 consecutive PDAC patients who completed neoadjuvant therapy and pancreaticoduodenectomy. We found that patients with HTRG 0 or 1 were associated with a lower frequency of lymph node metastasis (p=0.004) and recurrence (p=0.01), lower ypT (p <0.001) and AJCC stage (p <0.001), longer disease free survival (DFS, p=0.004) and overall survival (OS, p=0.02) than those with HTRG 2. However, there was no difference in either DFS or OS between the groups with CAP grade 2 and those with CAP grade 3 (p >0.05). In multivariate analysis, HTRG grade 0 or 1 was an independent prognostic factor for better DFS (p =0.03), but not OS. Therefore we validated the proposed HTRG scheme from our previous study. The proposed HTRG scheme is simple and easy to apply in practice by pathologists and might be used as a successful surrogate for longer DFS in patients with potentially resectable PDAC who completed neoadjuvant therapy and surgery.