肿瘤退缩分级标准的对比及其在直肠癌诊治中的应用进展

20161256ChinJColorecDis(ElectronicEdition),December2016,Vol.5,No.6458MDT51103SCI50DOI10.3877/cma.j.issn.2095-3224.2016.06.0012014No.2[e-mail]tumorregressiongradeanditsapplicationindiagnosisandtreatmentofrectalcancerTanYinuo,ChenHaiyan,DingKefeng.DepartmentofSurgicalOncology,TheSecondAffiliatedHospitalofZhejiangMedicalUniversity,Hangzhou310009,ChinaCorrespondingauthor:DingKefeng,Email:[e-mail]oajuvanttreatmentpopularizedinrectalcancertreatment,tumorregressiongrade(TRG)hasgraduallyattractedbroadattention.SeveralstudieshavevalidatedthatTRGcorrelatedwellwithneoajuvanttreatmentresponseandprognosisofpatients,thusTRGhasbroadapplicationprospectinprognosisprediction,follow-upandclinicaldecision,someotherresearchesbegantoconsideritasasurrogateendpointinclinicaltrials.However,differentsystemsofTRGcouldntbeunifiedandstandardized.ThisreviewwastomakeacomparisonofseveralpopularsystemsofTRGandexploretheclinicalapplicationofTRGinrectalcancertreatment.KeywordsRectalneoplasms;Prognosis;Tumorregressiongrade;Clinicaltrial20161256ChinJColorecDis(ElectronicEdition),December2016,Vol.5,No.6459tumorregressiongradeTRGTRGTRGTRGTRGTRGTRGTRGDworakMandardRodelBecker1-51Mandard3199493123TRG1~51TRGBecker200313610%50%TRG123TRG1aTRG1b10%364TRG19TRG223TRG32011480TRGDworak1997172TRG0~4TRG0TRG417RodelDworakTRG0~44TRG0TRG125%TRG225%~50%TRG350%TRG4TRG-MSKCC6AmericanJointCommitteeOnCancerAJCC7Wheeler58RCRG1TRGTRGTRGTRG9TRGTRGMeta143105484pathologiccompleteresponsepCRpCR583.3%vs65.6%pCR10pCR11TRGTRGpCRclinicalcompleteremissioncCR1213-142013Habr-Gama1320161256ChinJColorecDis(ElectronicEdition),December2016,Vol.5,No.6460cCR2~610ypT01cCRcCR69125351%cCR394%TRGTRGEORTC2292115TRGTRGdiseasefreesurvivalDFSoverallsurvivalOS16-172001181219pCR17pCREORTC22921FFCD92035-FupCR3%11.7%13.7%pCRDFSOS20-21pCR22-24pCRpCR-TRGpCRTRGpCRTRG2DFS252CAO/ARO/AIO-94101TRGMandard35Mandard33Becker1Dowrak/Rodel25Dowrak/Rodel23MSKCC6AJCC7RCRG5TRG0TRG1TRG1a25%TRG1b10%TRG210%~50%25%~50%25%~99%86%~99%TRG350%50%25%85%TRG4TRG520161256ChinJColorecDis(ElectronicEdition),December2016,Vol.5,No.6461297104415%pCR2441TRGpCR226TRGTRGTRG5TRGTRG[1]BeckerK,MuellerJD,SchulmacherC,etal.Histomorphologyandgradingofregressioningastriccarcinomatreatedwithneoadjuvantchemotherapy[J].Cancer,2003,98(7):1521-1530.[2]DworakO,KeilholzLandHoffmannA.Pathologicalfeaturesofrectalcancerafterpreoperativeradiochemotherapy[J].IntJColorectalDis,1997,12(1):19-23.[3]MandardAM,DalibardF,MandardJC,etal.Pathologicassessmentoftumorregressionafterpreoperativechemoradiotherapyofesophagealcarcinoma.Clinicopathologiccorrelations[J].Cancer,1994,73(11):2680-2686.[4]RodelC,MartusP,PapadoupolosT,etal.Prognosticsignificanceoftumorregressionafterpreoperativechemoradiotherapyforrectalcancer[J].Journalofclinicaloncology:officialjournaloftheAmericanSocietyofClinicalOncology,2005,23(34):8688-8696.[5]WheelerJM,WarrenBF,MortensenNJ,etal.Quantificationofhistologicregressionofrectalcancerafterirradiation:aproposalforamodifiedstagingsystem[J].Diseasesofthecolonandrectum,2002,45(8):1051-1056.[6]QuahHM,ChouJF,GonenM,etal.Pathologicstageismostprognosticofdisease-freesurvivalinlocallyadvancedrectalcancerpatientsafterpreoperativechemoradiation[J].Cancer,2008,113(1):57-64.[7]ZhangLN,XiaoWW,XiSY,etal.PathologicalAssessmentoftheAJCCTumorRegressionGradingSystemAfterPreoperativeChemoradiotherapyforChineseLocallyAdvancedRectalCancer[J].Medicine,2016,95(3):e2272.[8]WheelerJM,DoddsE,WarrenBF,etal.Preoperativechemoradiotherapyandtotalmesorectalexcisionsurgeryforlocallyadvancedrectalcancer:correlationwithrectalcancerregressiongrade[J].Diseasesofthecolonandrectum,2004,47(12):2025-2031.[9]PucciarelliS,ToppanP,FrisoML,etal.Completepathologicresponsefollowingpreoperativechemoradiationtherapyformiddletolowerrectalcancerisnotaprognosticfactorforabetteroutcome[J].Diseasesofthecolonandrectum,2004,47(11):1798-1807.[10]MaasM,NelemansPJ,ValentiniV,etal.Long-termoutcomeinpatientswithapathologicalcompleteresponseafterchemoradiationforrectalcancer:apooledanalysisofindividualpatientdata[J].TheLancetOncology,2010,11(9):835-844.[11]PatelUB,TaylorF,BlomqvistL,etal.Magneticresonanceimaging-detectedtumorresponseforlocallyadvancedrectalcancerpredictssurvivaloutcomes:MERCURYexperience[J].Journalofclinicaloncology:officialjournaloftheAmericanSocietyofClinicalOncology,2011,29(28):3753-3760.[12]PucciarelliS,DePaoliA,GuerrieriM,etal.Localexcisionafterpreoperativechemoradiotherapyforrectalcancer:resultsofamulticenterphaseIIclinicaltrial[J].Diseasesofthecolonandrectum,2013,56(12):1349-1356.[13]Habr-GamaA,SabbagaJ,Gama-RodriguesJ,etal.Watchandwaitapproachfollowingextendedneoadjuvantchemoradiationfordistalrectalcancer:arewegettingclosertoanalcancermanagement?[J].Diseasesofthecolonandrectum,2013,56(10):1109-1117.[14]MaasM,Beets-TanRG,LambregtsDM,etal.Wait-and-seepolicyforclinicalcompleterespondersafterchemoradiationforrectalcancer[J].Journalofclinicaloncology:officia