Tumor regression grade combined with post-therapy lymph node status: A novel independent prognostic factor for patients treated with neoadjuvant therapy followed by surgery in locally advanced gastroesophageal junction and gastric carcinoma.
Tumor regression grade combined with post-therapy lymph node status: A novel independent prognostic factor for patients treated with neoadjuvant therapy followed by surgery in locally advanced gastroesophageal junction and gastric carcinoma.
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肿瘤消退等级（TRG）是对新辅助治疗（NAT）的组织病理学应答的量度。治疗后淋巴结（ypN）转移被报告为预后因素。然而，NAT的治疗效果的评价还没有得到很好的研究。在这里，我们探讨TRG结合ypN状态是否可以作为胃食管连接部（GEJ）和胃癌（GC）的预后因素。此外，我们的目的是明确不同的新辅助治疗方案与不同的TRG和ypN状态之间的关系。回顾性收集2003年1月1日至2021年6月30日在北京大学肿瘤医院接受NAT的376例GEJ或GC患者。根据TRG和ypN状态，将患者创新性地分为四组：TRG 0 N 0、TRG 1 - 3 N 0、TRG 0 - 1 N+和TRG 2 - 3 N+。采用Kaplan-Meier方法和log-rank检验来验证四组间无病生存期（DFS）和总生存期（OS）的差异。单因素和多因素分析TRG联合ypN状态与预后的关系。我们观察到四组之间存在显著的生存差异（分别为p < 0.001）。TRG 0 N 0、TRG 1 - 3 N 0和TRG 0 - 1 N+患者未达到中位DFS和OS，而TRG 2 - 3 N+患者的中位DFS和OS分别为17. 37个月（95% CI，14. 14 - 20. 60个月）和39. 97个月（95% CI，27. 05 - 52. 89个月）。在多变量分析中，TRG结合ypN状态仍然是DFS（p < 0.001）和OS（p < 0.001）的独立预测因子。卡方检验显示TRG联合ypN状态与不同术前治疗显著相关（p < 0.001）。接受免疫治疗的患者达到了最高的TRG 0 N 0率（31.9%）。我们的研究结果表明，TRG结合ypN状态是可切除的局部晚期GEJ和GC的DFS和OS的新的独立预测因子。新辅助免疫治疗的TRG 0 N 0率最高。肿瘤消退分级（TRG）结合ypN状态是否可以作为胃食管连接部（GEJ）和胃癌（GC）的预后因素尚不清楚。在我们的研究中，我们回顾性分析了376例患者的资料，以阐明TRG联合ypN状态与预后的关系。这些患者创新性地分为四组：TRG 0 N 0、TRG 1 - 3 N 0、TRG 0 - 1 N+和TRG 2 - 3 N+。并结合ypN状态评价TRG的预测价值。我们的研究结果表明，TRG结合ypN状态是可切除的局部晚期GEJ和GC的DFS和OS的新的独立预测因子。新辅助免疫治疗的应用显著增加了TRG 0 N 0率，这代表了我们研究结果中的最佳预后。
Tumor regression grade (TRG) is a measure of histopathological response to neoadjuvant therapy (NAT). Post‐therapy lymph node (ypN) metastasis was reported as a prognostic factor. However, the evaluation of the treatment effectiveness of NAT has not been well studied. Here, we explored whether TRG combined with ypN status could be a prognostic factor for gastroesophageal junction (GEJ) and gastric cancer (GC). Besides, we aimed at making clear the association of different neoadjuvant regimens with different TRG and ypN status. 376 patients with GEJ or GC accepting NAT in Peking University Cancer Hospital were retrospectively collected from January 1, 2003 to June 30, 2021. According to TRG and ypN status, patients were innovatively categorized into four groups: TRG0N0, TRG1‐3N0, TRG0‐1N+, and TRG2‐3N+. We applied Kaplan–Meier method and log‐rank test to testify the differences in disease free survival (DFS) and overall survival (OS) among four groups. Univariate and multivariate analyses were performed to examine the relationships between TRG combined with ypN status and prognosis. We observed significant survival differences among the four groups (p < 0.001, respectively). Median DFS and OS of patients with TRG0N0, TRG1‐3N0, and TRG0‐1N+ were not reached, whereas these of patients with TRG2‐3N+ were 17.37 months (95% CI, 14.14–20.60 months) and 39.97 months (95% CI, 27.05–52.89 months). TRG combined with ypN status was still an independent predictor for both DFS (p < 0.001) and OS (p < 0.001) in multivariate analysis. Chi‐squared test showed TRG combined with ypN status was significantly associated with different preoperative treatments (p < 0.001). Patients receiving immunotherapy achieved the highest TRG0N0 rate (31.9%). Our results demonstrate that TRG combined with ypN status is a novel independent predictor of both DFS and OS in resectable, locally advanced GEJ and GC. Neoadjuvant immunotherapy achieved the highest TRG0N0 rate. Whether tumor regression grade (TRG) combined with ypN status could be a prognostic factor for gastroesophageal junction (GEJ) and gastric cancer (GC) was unclear. In our study, we retrospectively analyzed 376 patients’ data to elucidate the relationships between TRG combined with ypN status and prognosis. These patients were innovatively categorized into four groups: TRG0N0, TRG1‐3N0, TRG0‐1N+, and TRG2‐3N+. Then we evaluated the predictive value of TRG combined wiht ypN status. Our results suggest that TRG combined with ypN status is a novel independent predictor of both DFS and OS in resectable, locally advanced GEJ, and GC. The application of neoadjuvant immunotherapy significantly increased the TRG0N0 rate, which represented the best prognosis in our findings.
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DOI：
10.1002/cac2.12193
发表时间：
2021-08
期刊：
Cancer communications (London, England)
影响因子：
--
作者：
Wang FH;Zhang XT;Li YF;Tang L;Qu XJ;Ying JE;Zhang J;Sun LY;Lin RB;Qiu H;Wang C;Qiu MZ;Cai MY;Wu Q;Liu H;Guan WL;Zhou AP;Zhang YJ;Liu TS;Bi F;Yuan XL;Rao SX;Xin Y;Sheng WQ;Xu HM;Li GX;Ji JF;Zhou ZW;Liang H;Zhang YQ;Jin J;Shen L;Li J;Xu RH
通讯作者：
Xu RH
影响因子：
64.8
作者：
Lu Z;Zou J;Li S;Topper MJ;Tao Y;Zhang H;Jiao X;Xie W;Kong X;Vaz M;Li H;Cai Y;Xia L;Huang P;Rodgers K;Lee B;Riemer JB;Day CP;Yen RC;Cui Y;Wang Y;Wang Y;Zhang W;Easwaran H;Hulbert A;Kim K;Juergens RA;Yang SC;Battafarano RJ;Bush EL;Broderick SR;Cattaneo SM;Brahmer JR;Rudin CM;Wrangle J;Mei Y;Kim YJ;Zhang B;Wang KK;Forde PM;Margolick JB;Nelkin BD;Zahnow CA;Pardoll DM;Housseau F;Baylin SB;Shen L;Brock MV
通讯作者：
Brock MV
影响因子：
7.3
作者：
通讯作者：
--
影响因子：
9
作者：
Donohoe, Claire L.;O'Farrell, Naoimh J.;Reynolds, John V.
通讯作者：
Reynolds, John V.
影响因子：
9
作者：
Reynolds, John Vincent;Muldoon, Cian;Murphy, Thomas J.
通讯作者：
Murphy, Thomas J.