AJCC-TRG联合ypTN分期评价局部进展期直肠癌预后

doi:10.3760/cma.j.issn.1004-4221.2017.10.008

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摘要目的探讨AJCC-TRG分级联合ypTN分期评估局部进展期直肠癌(LARC)新辅助放化疗后的预后,并筛查预后最差的亚组人群。方法 2004—2012年间中山大学肿瘤防治中心收治LARC 263例,男176例,女87例,中位年龄55岁。所有患者接受术前新辅助放化疗,并于放疗结束后6~8周施行全直肠系膜切除术。根据第7版AJCC-TRG分级标准及ypTNM分期标准对术后组织标本重新评价。生存分析评价不同肿瘤退缩分级(TRG)联合ypTN对各项生存指标的预测情况。Kaplan-Meier法计算OS、DFS、LRFS及DMFS,Logrank法检验和单因素预后分析。结果中位随访时间为60.1个月,全组5年OS、DFS、LRFS和DMFS分别为80.0%、75.0%、97.0%和81.0%。不同ypT/TRG、ypN/TRG组合间的OS、DFS及DMFS差异均有统计学意义(P均<0.05)。ypT₃—T₄/TRG 2—3、ypN₁—N₂/TRG 2—3亚组预后最差,5年OS,DFS和DMFS分别为66.9%、56.0%,52.2%、41.4%和60.9%、46.0%。结论 AJCC-TRG联合ypTN分期能更准确评估LARC预后,筛查出高危远处转移预后最差亚组人群,对指导LARC个体化术后辅助治疗具有重要临床意义。

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	魏嘉旺
	肖巍魏
	奚少彦
	常晖
	王俏镟
	李力人
	张惠忠
	曾智帆
	丁培荣
	高远红

关键词 ：直肠肿瘤/新辅助疗法, 新辅助疗法, 放射, 新辅助疗法, 药物, 预后

Abstract： Objective To investigate the prognostic value of American Joint Committee on Cancer-tumor regression grading (AJCC-TRG) combined with ypTN stage in patients with locally advanced rectal cancer (LARC),who were treated with neoadjuvant chemoradiotherapy,and to identify the subgroups with the worst prognosis. Methods A total of 263 patients with LARC,including 176 males and 87 females,with a median age of 55 years,were admitted to Sun Yat-sen University Cancer Center from 2004 to 2012.All the patients received neoadjuvant chemoradiotherapy before surgery and underwent total mesorectal excision at 6 to 8 weeks after radiotherapy. All the surgical specimens were reevaluated according to the AJCC (7th edition)-TRG system and ypTN staging criteria. The prognostic prediction by TRG combined with ypTN was evaluated using survival analysis. The Kaplan-Meier method was used to calculate the rates of overall survival (OS),disease-free survival (DFS),local recurrence-free survival (LRFS),and distant metastasis-free survival (DMFS).The log-rank test was used for survival comparison and univariate prognostic analysis. Results The median follow-up was 60.1 months. The 5-year rates of OS,DFS,LRFS,and DMFS for all patients were 80.0%,75.0%,97.0%,and 81.0%,respectively. There were significant differences in OS,DFS,and DMFS between different ypT/TRG subgroups and different ypN/TRG subgroups (all P<0.05).ypT_3-4/TRG 2-3 and ypN_1-2/TRG 2-3 subgroups showed the worst prognosis. The 5-year rates of OS,DFS,and DMFS of the two subgroups were 66.9%/56.0%,52.2%/41.4%,and 60.9%/46.0%,respectively. Conclusions A combination of AJCC-TRG system and ypTN staging can better predict the prognosis of LARC and identify the subgroups with the worst prognosis,which may provide a clinical guidance for postoperative individualized decision on adjuvant therapy for LARC.

Key words：　Rectal neoplasms/neoadjuvant therapy Neoadjuvant therapy,radiotherapy Neoadjuvant therapy,drug Prognosis

收稿日期: 2017-03-02

通讯作者: 高远红,Email:gaoyh@sysucc.org.cn

引用本文:

魏嘉旺,肖巍魏,奚少彦等. AJCC-TRG联合ypTN分期评价局部进展期直肠癌预后[J]. 中华放射肿瘤学杂志, 2017, 26(10): 1147-1150.

Wei Jiawang,Xiao Weiwei,Xi Shaoyan et al. Prognostic value of American Joint Committee on Cancer-tumor regression grading combined with ypTN staging in patients with locally advanced rectal cancer　[J]. Chinese Journal of Radiation Oncology, 2017, 26(10): 1147-1150.

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http://journal12.magtechjournal.com/Jweb_fszlx/CN/10.3760/cma.j.issn.1004-4221.2017.10.008 或 http://journal12.magtechjournal.com/Jweb_fszlx/CN/Y2017/V26/I10/1147

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