胃癌新辅助治疗后不同肿瘤退缩分级系统的预后预测价值

目的 探讨不同肿瘤退缩分级（tumor regression grade，TRG）标准（Mandard-TRG、Becker-TRG及JGCA-TRG）与局部进展期胃癌患者新辅助治疗术后病理特征的关系，并比较其预后预测价值。方法 回顾性收集行新辅助治疗及胃癌根治术的局部进展期胃癌患者，根据Mandard-TRG、Becker-TRG及JGCA-TRG对术后组织标本进行重新评价，分析各肿瘤退缩分级标准与临床病理特征的关系及对预后的预测价值。结果 共纳入198例接受过新辅助治疗的局部进展期胃癌患者，其中男性152例，女性46例。三种TRG标准划分的不同肿瘤退缩分级间肿瘤直径、ypT、ypN、脉管浸润、神经侵犯的构成比例均具有统计学差异。Kaplan-Meier分析显示不同Becker分级或JGCA分级之间的OS具有统计学差异（p=0.019，p=0.035），而不同Mandard分级之间的OS差异不显著（p=0.146）。进一步比较Becker 1a-2级和Becker 3级患者的生存情况，Becker 1a-2级患者的预后显著优于Becker 3级患者（p=0.002），JGCA 2-3级患者的预后亦显著优于JGCA 0-1b级患者（p=0.006）。COX回归分析显示三种肿瘤退缩分级均非新辅助治疗后胃癌患者的独立预后因子。三种分级预测5年生存状态的ROC曲线下面积分别为0.608、0.624和0.611。结论 Becker-TRG对于接受新辅助治疗的胃癌患者的预后预测价值略优于JGCA-TRG和Mandard-TRG，仍需探索更加全面精准的胃癌新辅助治疗后病理评价标准。

Prognostic value of different tumor regression grade systems for patients with locally advanced gastric cancer receiving neoadjuvant therapy

Objective: To investigate the relationship between different tumor regression grade systems( ypTNM stage, Mandard-TRG grade, Becker-TRG grade, and JGCA-TRG grade) and clinicopathological characteristics of patients with locally advanced gastric cancer after receiving neoadjuvant therapy, and compare the prognostic value of these systems. Methods: Patients with locally advanced gastric cancer who received neoadjuvant therapy followed by radical gastrectomy were retrospectively collected. Postoperative tissue samples were re-evaluated according to AJCC 8th ypTNM stage, Mandard-TRG, Becker-TRG, and JGCA-TRG. Relationships between various tumor regression grade systems and clinicopathological characteristics and the prognostic value of these systems were analyzed. Results: A total of 198 patients with locally advanced gastric cancer who received neoadjuvant therapy were included, of whom 152 were male and 46 were female. The composition ratios of tumour size, ypT, ypN, vascular infiltration, and nerve invasion were statistically different among different tumor regression grades classified by three TRG criteria. Kaplan-Meier analysis showed statistically significant differences in OS between different Becker grades or JGCA grades (p=0.019, p=0.035), while the differences in OS between different Mandard grades were not significant(p=0.146). Further comparing the survival of Becker 1a-2 and Becker 3 patients, the prognosis of Becker 1a-2 patients was significantly better than that of Becker 3 patients (p=0.002), and the prognosis of JGCA 2-3 patients was also significantly better than that of JGCA 0-1b patients (p=0.006). COX regression analysis showed that none of the three tumor regression grades was an independent prognostic factor for patients with gastric cancer receiving neoadjuvant therapy. The area under ROC curves(AUC) of three TRG systems to predict the 5 year overall survival was 0.608,0.624 and 0.611. Conclusions: Becker-TRG have a slightly better prognostic value than JGCA-TRG and Mandard-TRG for gastric cancer patients receiving neoadjuvant therapy, but there is still an urgent need to explore more comprehensive and precise criteria for pathological evaluation of gastric cancer after neoadjuvant therapy.