Histomorphologic tumor regression and lymph node metastases determine prognosis following neoadjuvant radiochemotherapy for esophageal cancer - implications for response classification
Histomorphologic tumor regression and lymph node metastases determine prognosis following neoadjuvant radiochemotherapy for esophageal cancer - implications for response classification
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DOI：
10.1097/01.sla.0000186170.38348.7b
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发表时间：
2005-11-01
影响因子：
9
通讯作者：
Hoelscher, AH
中科院分区：
文献类型：
--
作者：
Schneider, PM;Baldus, SE;Hoelscher, AH
目的：我们试图定量和客观地评估组织形态学肿瘤的回归，并建立一个相关的预后回归分类系统，食管癌患者接受新辅助放化疗.Patients和方法：85例连续患者局部食管癌（cT 24，NX，M0）接受标准化的新辅助放化疗（顺铂，5-氟尿嘧啶，36戈伊）。74例（87%）患者接受了经胸整块食管切除术和2野淋巴结清扫术。对切除标本的整个瘤床进行组织形态学评价，并根据存活残留肿瘤细胞（VRTC）的百分比将消退分为I至IV级。当标本中VRTC含量低于10%时，（III级）或病理完全缓解（四级）。74例患者中有66例（89%）进行了完全切除（R 0），R 0切除病例的3年生存率为54% ± 7.05%，新辅助治疗期间不完全切除或肿瘤进展的患者的3年生存率为0%（P < 0.01）。44例（59.5%）肿瘤出现轻微组织病理学缓解，30例（40.5%）肿瘤出现重大组织病理学缓解。观察到显著不同的3年生存率（轻微缓解为38.8% +/- 8.1%，严重缓解为70.7 +/- 10.1%）。单因素生存分析显示肿瘤组织形态学消退（P < 0.004）和淋巴结类型（P < 0.01）是影响预后的重要因素。病理T分类（P < 0.08）、组织学类型（P = 0.15）或分级（P = 0.33）对生存率无显著影响。考克斯回归分析发现，二分回归等级（轻微和主要组织形态学回归，P < 0.028）和淋巴结状态（ypN 0和ypN 1，P < 0.036）是显著的独立预后参数。建立了一个包括组织形态学消退（Major vs Minor）和淋巴结状态（ypN 0 vs ypN 1）的双参数回归分类系统（P < 0.001）。结论：组织形态学肿瘤消退和淋巴结状态（ypN）是食管癌新辅助放化疗后完全切除（R 0）患者的重要预后参数。基于2个参数的回归分类可改善对治疗方案有效性的客观评价、分期和再分期模式的准确性以及分子反应预测。
Objective: We sought to quantitatively and objectively evaluate histomorphologic tumor regression and establish a relevant prognostic regression classification system for esophageal cancer patients receiving neoadjuvant radiochemotherapy.Patients and Methods: Eighty-five consecutive patients with localized esophageal cancers (cT24, Nx, M0) received standardized neoadjuvant radiochemotherapy (cisplatin, 5-fluorouracil, 36 Gy). Seventy-four (87%) patients were resected by transthoracic en bloc esophagectomy and 2-field lymphadenectomy. The entire tumor beds of the resected specimens were evaluated histomorphologically, and regression was categorized into grades I to IV based on the percentage of vital residual tumor cells (VRTCs). A major response was achieved when specimens contained either less than 10% VRTCs (grade III) or a pathologic complete remission (grade IV).Results: Complete resections (R0) were performed in 66 of 74 (89%) patients with 3-year survival rates of 54% +/- 7.05% for R0-resected cases and 0% for patients with incomplete resections or tumor progression during neoadjuvant therapy (P < 0.01). Minor histopathologic response was present in 44 (59.5%) and major histopathologic response in 30 (40.5%) tumors. Significantly different 3-year survival rates (38.8% +/- 8.1% for minor versus 70.7 +/- 10.1% for major response) were observed. Univariate survival analysis identified histomorphologic tumor regression (P < 0.004) and lymph node category (P < 0.01) as significant prognostic factors. Pathologic T category (P < 0.08), histologic type (P = 0.15), or grading (P = 0.33) had no significant impact on survival. Cox regression analysis identified dichotomized regression grades (minor and major histomorphologic regression, P < 0.028) and lymph node status (ypN0 and ypN1, P < 0.036) as significant independent prognostic parameters. A 2-parameter regression classification system that includes histomorphologic regression (major versus minor) and nodal status (ypN0 versus ypN1) was established (P < 0.001).Conclusions: Histomorphologic tumor regression and lymph node status (ypN) were significant prognostic parameters for patients with complete resections (R0) following neoadjuvant radiochemotherapy for esophageal cancer. A regression classification based on 2 parameters Could lead to improved objective evaluation of the effectiveness of treatment protocols, accuracy of staging and restaging modalities, and molecular response prediction.