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

Abstract
Figure/Table
References()
Related Citation (15)
Read Tracking
Download Tracking

Download: PDF (1508 KB) HTML (1 KB)
Export: BibTeX | EndNote (RIS) Supporting Info

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.

	Service

	E-mail this article
	Add to my bookshelf
	Add to citation manager
	E-mail Alert
	RSS
	Articles by authors
	Wei Jiawang
	Xiao Weiwei
	Xi Shaoyan
	Chang Hui
	Wang Qiaoxuan
	Li Liren
	Zhang Huizhong
	Zeng Zhifan
	Ding Peirong
	Gao Yuanhong

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

Received: 02 March 2017

Corresponding Authors: Gao Yuanhong,Email:gaoyh@sysucc.org.cn.

Cite this article:

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.

URL:

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

[1] Trakarnsanga A,Gonen M,Shia J,et al. Comparison of tumor regression grade systems for locally advanced rectal cancer after multimodality treatment[J].J Natl Cancer Inst,2014,106(10):dju248.DOI:10.1093/jnci/dju248.
[2] Gao YH,Lin JZ,An X,et al. Neoadjuvant sandwich treatment with oxaliplatin and capecitabine administered prior to,concurrently with,and following radiation therapy in locally advanced rectal cancer:a prospective phase 2 trial[J].Int J Radiat Oncol Biol Phys,2014,90(5):1153-1160.DOI:10.1016/j.ijrobp.2014.07.021
[3] Mandard AM,Dalibard F,Mandard JC,et al. Pathologic assessment of tumor regression after preoperative chemoradiotherapy of esophageal carcinoma. Clinicopathologic correlations[J].Cancer,1994,73(11):2680-2686.
[4] Fokas E,Liersch T,Fietkau R,et al. Tumor regression grading after preoperative chemoradiotherapy for locally advanced rectal carcinoma revisited:updated results of the CAO/ARO/AIO-94 trial[J].J Clin Oncol,2014,32(15):1554-1562.DOI:10.1200/JCO.2013.54.3769.
[5] Vecchio FM,Valentini V,Minsky BD,et al. The relationship of pathologic tumor regression grade (TRG) and outcomes after preoperative therapy in rectal cancer[J].Int J Radiat Oncol Biol Phys,2005,62(3):752-760.DOI:10.1016/j.ijrobp.2004.11.017.
[6] Capirci C,Valentini V,Cionini L,et al. Prognostic value of pathologic complete response after neoadjuvant therapy in locally advanced rectal cancer:long-term analysis of 566 ypCR patients[J].Int J Radiat Oncol Biol Phys,2008,72(1):99-107.DOI:10.1016/j.ijrobp.2007.12.019.
[7] Dhadda AS,Dickinson P,Zaitoun AM,et al. Prognostic importance of Mandard tumour regression grade following pre-operative chemo/radiotherapy for locally advanced rectal cancer[J].Eur J Cancer,2011,47(8):1138-1145.DOI:10.1016/j.ejca.2010.12.006.
[8] Zhang LN,Xiao WW,Xi SY,et al. Pathological Assessment of the AJCC Tumor Regression Grading System After Preoperative Chemoradiotherapy for Chinese Locally Advanced Rectal Cancer[J].Medicine,2016,95(3):e2272.DOI:10.1097/MD.0000000000002272.
[9] Shia J,Guillem J G,Moore H G,et al. Patterns of morphologic alteration in residual rectal carcinoma following preoperative chemoradiation and their association with long-term outcome[J].Am J Surg Pathol,2004,28(2):215.
[10] Rodel C,Martus P,Papadoupolos T,et al. Prognostic significance of tumor regression after preoperative chemoradiotherapy for rectal cancer[J].J Clin Oncol,2005,23(34):8688-8696.DOI:10.1200/JCO.2005.02.1329.
[11] 彭海花,游凯云,王成涛,等.局部晚期直肠癌新辅助放化疗术后病理分期对预后影响[J].中华放射肿瘤学杂志,2013,22(6):439-442.DOI:10.3760/cma.j.issn.1004-4221.2013.06.005.
Peng HH,You KY,Wang CT,et al. Prognostic effects of pathological stages in patients with locally advanced rectal cancer after neoadjuvant radiochemotherapy plus radical surgery[J].Chin J Radiat Oncol,2013,22(6):439-442.DOI:10.3760/cma.j.issn.1004-4221.2013.06.005.
[12] Sarli L,Bader G,Iusco D,et al. Number of lymph nodes examined and prognosis of TNM stage Ⅱ colorectal cancer[J].Eur J Cancer,2005,41(2):272-279.DOI:10.1016/j.ejca.2004.10.010.