Classification of Pathologic Response to Neoadjuvant Therapy in Esophageal and Junctional Cancer Assessment of Existing Measures and Proposal of a Novel 3-Point Standard
Classification of Pathologic Response to Neoadjuvant Therapy in Esophageal and Junctional Cancer Assessment of Existing Measures and Proposal of a Novel 3-Point Standard
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DOI：
10.1097/sla.0b013e3182a66588
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发表时间：
2013-11-01
影响因子：
9
通讯作者：
Reynolds, John V.
中科院分区：
文献类型：
--
作者：
Donohoe, Claire L.;O'Farrell, Naoimh J.;Reynolds, John V.
目的：为了评估现有的措施，食管和交界处癌的新辅助治疗的病理反应，并建议一个最佳的classification.Background：多模式治疗越来越多的护理标准，局部晚期食管癌。许多措施的病理反应进行了研究，但是，没有国际标准化存在，并没有措施纳入目前的美国联合委员会癌症staging system.Methods：共393例连续完成多模式治疗的患者进行了研究，所有前瞻性记录的Mandard肿瘤消退等级（TRG）。比较了其他7种已发表的缓解方法，并测试了一种新型3点TRG [TRG 1（完全）; TRG 2/3（部分）; TRG 4/5（无/最小）]。200个综合分期patients.Results的连续子集中评估了淋巴结消退的临床和病理证据：所有模型具有相似的判别和分层能力，在单变量分析中预测生存率（P < 0.0001）。相反，只有3点TRG（P = 0.042）沿着与ypN（P < 0.001）和ypT分期（P < 0.001）独立预测生存。TRG 1的中位生存期为71个月，TRG 2/3和TRG 4/5分别为30和17个月（P < 0.0001）。TRG 1组、TRG 2/3组和TRG 4/5组中分别有64%、30%和5%的患者出现明显的淋巴结完全反应（cN 1至ypN 0）（P < 0.0001）。完全缓解（TRG 1）定义了新辅助治疗后的独特队列，与淋巴结缓解和总生存率密切相关。该分类值得考虑用于治疗反应的标准化，并纳入分期命名法。
Objective: To assess existing measures of pathologic response to neoadjuvant therapy in esophageal and junctional cancer, and to recommend an optimum classification.Background: Multimodal therapy is increasingly the standard of care for locally advanced esophageal cancer. Numerous measures of pathologic response have been studied; however, no international standardization exists and no measure is incorporated into the current American Joint Committee on Cancer staging system.Methods: A total of 393 consecutive patients completing multimodal therapy were studied, all with prospectively recorded Mandard tumor regression grades (TRG). Seven other published methods of response were compared, and a novel 3-point TRG [TRG 1 (complete); TRG 2/3 (partial); TRG 4/5 (none/minimal)] was tested. Clinical and pathologic evidence of nodal regression was assessed in a consecutive subset of 200 comprehensively staged patients.Results: All models had similar discriminatory and stratification power, and they predicted survival (P < 0.0001) on univariate analysis. Conversely, only the 3- point TRG (P = 0.042) along with ypN (P < 0.001) and ypT stage (P < 0.001) independently predicted survival. The median survival for TRG1 was 71 months compared with 30 and 17 months for TRG 2/3 and TRG 4/5, respectively (P < 0.0001). Apparent complete nodal response (cN1 to ypN0) was seen in 64% of the TRG 1 group, 30% of the TRG 2/3 group, and 5% of the TRG 4/5 group (P < 0.0001).Conclusions: No existing response measure independently predicts outcome. A complete response (TRG 1) defines a unique cohort after neoadjuvant therapy, associated closely with nodal response, and overall survival. This classification merits consideration for standardization of treatment response, and for inclusion in staging nomenclature.