Evaluation Of Tumor Regression Grading With Prognostic Significance After Neoadjuvant Therapy In Locally Advanced Rectal Cancer

ObjectiveRectal cancer is one of the most common malignant tumors in China even all over the world,with the change of the environmental factor, dietary formation,life style there is an upward trend in the incidence rate in recent years. The rate of the morbidity is growing from the age of the 40,and get the highest at the age of 50-55. Low rectal has a high incidence rate in China,proportion about 75% in Rectal Cancer.But Low locally advanced rectal cancer is a clinical therapeutic challenge just take surgery cannot acquire satisfied result,on the contrary improve the surgery of injury and syndromes,cannot improve the rate of local tumor control.Neoadjuvant chemoradiotherapy(nCRT) followed by total mesorectal excision techniques and adjuvant chemotherapy,has become the standard for the management of locally advanced rectal tumor,enhancing curative resection and improving the rate of local tumuor control. Histologic changes after preopreative nCRT for rectal cancer vary considerable, with some showing complete absence of tumor cells, but others exhibit little or no regressive changes. This study was conducted in attempt to study the locally advanced rectal cancer after neoadjuvant therapy, prognostic of tuomr regression grading.MethodsConsecutive patients with locally advanced rectal cancer from The First Affiliated Hospital of Kunming Medical University between December 2009 and December 2012 were included.The inclusion criteria were:preoperation line fiber colonoscopy; confirmed by pathology of rectal gland carcinoma,preoperation assessment of clinical stage T3-4N0M0 or TxN+MO;preoperative neoadjuvant therapy; preoperative KPS score 80 points or more; operation are performed by the same surgery group; eliminate standard:pre-operation with obstruction, tumor rupture bleeding, and so on, preoperation without basic diseases such as anemia、 hypoproteinemia and cardiovascular and cerebrovascular diseases, and cannot tolerate neoadjuvant chemoradiotherapy or operation.61 patients with locally advanced rectal cancer underwent neoadjuvant therapy before surgery. Biopsyspecimens were reevaluated to identify tumor regression garding(TRG).Correlations of TRG to prognostic factors, compare difference TRG with difference prognostic. Record statistics used by excel,and the survival was estimated by spss17.0.ResultsAccording to the tumor regression garding(TRG),among 61 patients, TRG1 was found 24 (39.3%); TRG2 was found 19 (31.2%); TRG3 was found 18例 (29.5%).Local Recurrence Rate was 8.3% for TRG1,15.8% for TRG2,and 38.9% for TRG3 (P=0.042);Distant Metastasis Rate was 8.3% for TRG1,21.1% for TRG2,and 44.4% for TRG3 (P=0.042); Two-year Progression-free survival:was 79.2% for TRGl,was 57.9% for TRG2, and 33.6% for TRG3(P=0.011); Two-year Overall Ssuvival:was 95.8% for TRG1, was 89.5% for TRG2, and 61.6% for TRG3 (P=0.008)ConclusionLocally advanced rectal cancer underwent neoadjuvant therapy, different tumor regression garding had different prognosis.Tumor regression more obvious, patients had better prognosis. So,we could estimate prognosis factors use by TRG...