直肠癌新辅助治疗后病理评估

Pathological evaluation after preoperative neoadjuvant treatment in rectal cancer

术前新辅助治疗在直肠癌中得到了广泛推广．术后规范化病理评估也逐渐引起广泛的关注。准确的病理学检查在直肠癌的诊治流程中发挥着“承前启后”的作用．既能评判新辅助放化疗及手术切除的效果．又能指导术后辅助治疗和评估患者预后。肿瘤退缩分级（TRG）的病理评估和TNM分期是直肠癌常规病理诊断的基础，与患者的生存预后息息相关。目前，针对新辅助放化疗后TRG评价方法主要有NCCN、AJCC、Becke、Mandard、Dowrak／R6del、MSKCC及RCRG等标准，但尚无一个公认的最佳标准．实践工作中较常使用的分级为AJCC和NCCN的TRG分级标准。准确进行TRG分级的前提是详细、规范的病理学评估．包括大体标本评估和镜下评估。如何评价新辅助治疗后淋巴结转移灶的治疗反应以及如何提高病理医师间评估的一致性是目前仍待解决的问题．

Preoperative neoadjuvant therapy of rectal cancer has been widely promoted, and postoperativestandardized pathological assessment has gradually attracted widespread attention. Accurate pathological examination plays an indicating role in the diagnosis and treatment of rectal cancer, which can not only evaluate the effects of neoadjuvant chemoradiation and surgical resection, but also guide postoperative adjuvant therapy and assess the prognosis. Tumor regression grade （TRG） and TNM staging are the bases of routine pathological diagnosis of rectal cancer, and they are closely related to patient survival and prognosis. At present, TRG evaluation methods for neoadjuvant ehemoradiation include NCCN, AJCC, Beeke, Mandard, Dowrak/Rodel, MSKCC, and RCRG. However, there is still no universally accepted best standard. The commonly used classifications in practice are AJCC and NCCN TRG grading standards. The prerequisite for accurate TRG classification is a detailed and standardized pathological assessment, which includes both gross assessment of the specimen and microscopic examination. How to evaluate the therapeutic response to lymph node metastasis after neoadjuvant therapy and improve the assessment consistency among pathologists are the two major issues that remain to be resolved.