AJCC—TRG联合ypTN分期评价局部进展期直肠癌预后

Prognostic value of American Joint Committee on Cancer-tumor regression grading combined with ypTN staging in patients with locally advanced rectal cancer

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。

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）.ypT3-4/TRG 2-3 and ypN1-2/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.