| [Purpose]Neoadjuvant therapy(NAT)combined with total mesorectal excision(TME surgery)has become the standard treatment method for locally advanced rectal cancer(LARC).However,different patients respond differently to NAT,from no response to complete response,which results in different prognosis.ypTNM staging is the most commonly used tumor pathological staging method after neoadjuvant therapy,which has a significant correlation with prognosis.Tumor regression grading(TRG grading)can quantitatively evaluate the tumor regression response and objectively reflect the efficacy of NAT.This study evaluated the value of ypTNM staging and TRG grading in predicting the prognosis of patients after NAT to provide the basis for the formulation of clinical treatment plans.[Method]The clinical and pathological data of 269 patients with LARC who underwent NAT combined with TME surgery were retrospectively analyzed.According to the American joint committee on cancer(AJCC)Seventh edition of TNM staging and TRG grading criteria of rectal cancer to re-evaluate the postoperative specimen.Taking the local recurrence-free survival(LRFS),distant metastasis-free survival(DMFS)and disease-free survival(DFS)as study endpoints.Kaplan-Meier univariate survival analysis and Cox proportional hazard regression analysis were used to determine prognostic factors.The area under the receiver operating curve(ROC)was used to compare the prognostic value of ypTNM staging and TRG grading.[Result]The 5-year DFS rate was 63.9%.On univariate analysis,CEA concentration after NAT,ypT,ypN,ypTNM staging,and TRG grading were significantly correlated with LRFS,DMFS and DFS(all the p-value were less than 0.05).Multivariate survival analysis showed that TRG grading was an independent prognostic factor for LRFS and DFS(all the p-value were less than 0.05).The comparison of the area under the ROC curve showed that TRG grading was more valuable than ypTNM staging in predicting LRFS.And the predictive value of ypTNM staging was better in predicting DMFS and DFS.[Conclusion]Both ypTNM staging and TRG grading can effectively predict the prognosis of patients.In predicting patients’ DMFS and DFS,ypTNM staging shows a better prognostic value.The TRG grading is an independent prognostic factor for LRFS and DFS,and it has a better prognostic value in predicting LRFS.Therefore,TRG grading could be used as an effective complement to ypTNM staging in predicting the prognosis of patients.We recommend using TRG grading to predict the prognosis of patients and to make risk stratification of patients,in order to guide the development of clinical treatment plans and serve as an alternative endpoint for clinical research. |
