Quantified pathologic response assessed as residual tumor burden is a predictor of recurrence-free survival in patients with rectal cancer who undergo resection after neoadjuvant chemoradiotherapy.
Quantified pathologic response assessed as residual tumor burden is a predictor of recurrence-free survival in patients with rectal cancer who undergo resection after neoadjuvant chemoradiotherapy.
复制标题
作者：
Agarwal A;Chang GJ;Hu CY;Taggart M;Rashid A;Park IJ;You YN;Das P;Krishnan S;Crane CH;Rodriguez-Bigas M;Skibber J;Ellis L;Eng C;Kopetz S;Maru DM
目的：确定以残留肿瘤细胞百分比评估的量化病理反应是否能预测直肠癌患者的无复发生存(RFS)。我们对251例直肠腺癌患者进行了新辅助放化疗和根治性切除术。量化的病理反应被定义为与肿瘤床有关的残留癌细胞的估计比例：完全，没有残留癌细胞；接近完全，≤5%；主要，5%和50%；和轻微，≥50%。对随机选择的55名患者中未显示完全反应的肿瘤，对两位病理学家之间量化病理反应的重复性进行了评估。病理反应完全者占21%，接近完全者占20%，重度者占37%，轻度者占22%。19%的患者患有ypT0N0病，27%的患者患有ypT1-2N0，21%的患者患有ypT3-4N0，33%的患者患有N+。根据量化的病理反应类别，5年RFS率如下：完全，95%；接近完全，88%；主要，69%；和轻微，61%(P<；0.001)。在多因素分析中，大反应和小反应、高组织学分级和神经侵袭是RFS降低的显著预测因素。PT3-4或N+病患者的5年无症状缓解率(94%)好于大反应(%)或轻微反应(61%)患者(P<；0.02)。两位病理学家之间观察到中度到实质性的一致性(κ=0.72)。量化的病理反应是直肠腺癌患者RFS的预测因子，并对病理分期较高的患者进行分层。
To determine whether quantified pathologic response assessed as a percentage of residual tumor cells predicts recurrence-free survival (RFS) in patients with rectal cancer. We studied 251 patients with rectal adenocarcinoma treated with neoadjuvant chemoradiation and radical resection. Quantified pathologic response was defined as an estimated proportion of residual cancer cells in relation to the tumor bed: complete, no residual cancer cells; near complete, ≤5%; major, >5% and <50%; and minor, ≥50%. The reproducibility of quantified pathologic response between 2 pathologists was assessed using tumors that did not show a complete response from 55 randomly selected patients. Pathologic response was complete in 21% of patients, near complete in 20%, major in 37%, and minor in 22%. Nineteen percent of patients had ypT0N0 disease, 27% ypT1-2N0, 21% ypT3-4N0, and 33% N+. The 5-year RFS rates by category of quantified pathologic response were as follows: complete, 95%; near complete, 88%; major, 69%; and minor, 61% (P < 0.001). Major and minor response, high histologic grade, and perineural invasion were significant predictors of decreased RFS in multivariate analysis. The 5-year RFS rates for patients with ypT3-4 or N+ disease were better for those with a near complete response (94%) than for those with a major (64%) or minor (61%) response (P < 0.02). Moderate to substantial agreement was observed between the 2 pathologists (κ = 0.72). Quantified pathologic response is a predictor of RFS in patients with rectal adenocarcinoma and stratifies patients with high pathologic stage disease.