Pathological response following long-course neoadjuvant chemoradiotherapy for locally advanced rectal cancer
Pathological response following long-course neoadjuvant chemoradiotherapy for locally advanced rectal cancer
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DOI：
10.1111/j.1365-2559.2005.02176.x
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发表时间：
2005-08-01
期刊：
影响因子：
6.4
通讯作者：
Sheahan, K
中科院分区：
文献类型：
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作者：
Ryan, R;Gibbons, D;Sheahan, K
目的：对局部晚期疾病(T3/T4)新辅助放化疗后直肠癌全直肠系膜切除标本进行标准化病理分析。方法与结果：对60例长期放化疗后行全直肠系膜切除的患者进行标准化解剖和报告。肿瘤消退由两位病理学家(K.S.，D.G.)进行评分。使用已建立的5分肿瘤回归分级(TRG)和新的3分分级。这两个评分都被评估为观察者间的变异性。完全或接近完全病理反应(3点TRG1)10例(17%)。使用5点TRG，两位病理学家之间有很好的一致性(kappa=0.64)。使用3分评分时，一致性非常好(kappa=0.84)。平均随访22个月，病理完全或接近完全缓解(TRG1)的患者无复发报告。结论：肿瘤消退分级是直肠癌放化疗后肿瘤反应的一种有用的评分方法。TRG1和TRG2可视为完全病理反应(YpT0)。改良的3分评分具有更好的重复性，具有相似的预后意义。
Aims: To standardize the pathological analysis of total mesorectal excision specimens of rectal cancer following neoadjuvant chemoradiotherapy for locally advanced disease (T3/T4), including tumour regression.Methods and results: Standardized dissection and reporting was used for 60 patients who underwent total mesorectal excision following long-course chemoradiotherapy. Tumour regression was scored by two pathologists (K.S., D.G.) using both an established 5-point tumour regression grade (TRG), and a novel 3-point grade. Both scores were evaluated for interobserver variability. A complete or near-complete pathological response (3-point TRG 1) was found in 10 patients (17%). Using the 5-point TRG, there was good agreement between both pathologists (kappa = 0.64). Using the 3-point grade, agreement was excellent (kappa = 0.84). No disease recurrence has been reported in patients with a complete, or near complete pathological response (3-point TRG 1), after a mean follow-up of 22 months.Conclusion: Tumour regression grade is a useful method of scoring tumour response to chemoradiotherapy in rectal cancer. TRG 1 and 2 can be regarded as a complete pathological response (ypT0). A modified 3-point grade has the advantage of better reproducibility, with similar prognostic significance.