Objective: 

This study aims at constructing a staging system incorporating tumor regression grade and ypN-category (TRG-N) in patients with neoadjuvant therapy before esophagectomy. It is hypothesized that this would prognosticate better than the current American Joint Committee on Cancer (AJCC) postneoadjuvant therapy (ypTNM) stage groups.

Background: 

Conventional pathological T-category is defined by the depth of invasion, and may lose prognostic relevance after neoadjuvant therapy. TRG defines treatment response by the degree of tumor regression, and when combined with ypN-category may be more prognostic than AJCC postneoadjuvant therapy (ypTNM) stage groups.

Methods: 

A training cohort of 210 patients with esophageal squamous cell carcinoma and who had had neoadjuvant therapy before esophagectomy were studied. A validation cohort comprised 107 patients from another hospital. Resected esophagi were assessed by ypT-category and TRG, the latter assigned according to the Becker 4-tier system. These categories were grouped with ypN-category into a TRG-N system. Patients’ survival was compared between the current AJCC postneoadjuvant therapy (ypTNM) stage groups and this TRG-N system.

Results: 

In the training cohort, 5-year survival rates according to ypTNM stage I, II, IIIA, IIIB, and IVA were 53%, 39.4%, 47%, 18.3%, and 0%, respectively. For TRG-N stages I, II, III, and IV, the respective figures were 59.6%, 43.5%, 23.8%, and 15.6%. TRG-N stage showed better fit in survival than ypTNM stage groups, indicated by lower Akaike Information Criteria (AIC) and Bayesian Information Criterion values. Similar results were found in the validation cohort. Multivariate analysis showed that TRG-N stage (P=0.02), age (P=0.006), and sex (P=0.005) were independent prognostic factors.

Conclusion: 

TRG-N stage shows better prognostication than the AJCC postneoadjuvant therapy (ypTNM) stage groups.

中文翻译：

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一种将肿瘤消退等级 (TRG) 与淋巴结状态（ypN 类别）相结合的新型肿瘤分期系统在食管鳞状细胞癌新辅助治疗后的预后优于 ypTNM 分期组

客观的： 

本研究旨在为食管切除术前新辅助治疗的患者构建一个结合肿瘤消退分级和 ypN 类别 (TRG-N) 的分期系统。据推测，这将比目前的美国癌症联合委员会 (AJCC) 新辅助治疗后 (ypTNM) 阶段组具有更好的预后。

背景： 

常规病理 T 分类由浸润深度定义，新辅助治疗后可能失去预后相关性。TRG 通过肿瘤消退的程度来定义治疗反应，并且当与 ypN 类别相结合时，可能比 AJCC 新辅助治疗后 (ypTNM) 分期组更具预后性。

方法： 

研究了 210 名食管鳞状细胞癌患者的训练队列，这些患者在食管切除术前接受过新辅助治疗。验证队列包括来自另一家医院的 107 名患者。切除的食管通过 ypT 类别和 TRG 进行评估，后者根据 Becker 4 层系统分配。这些类别与 ypN 类别一起分组到 TRG-N 系统中。比较了当前 AJCC 新辅助治疗 (ypTNM) 阶段组和该 TRG-N 系统之间的患者存活率。

结果： 

在训练队列中，根据 ypTNM I、II、IIIA、IIIB 和 IVA 期的 5 年生存率分别为 53%、39.4%、47%、18.3% 和 0%。对于 TRG-N 阶段 I、II、III 和 IV，分别为 59.6%、43.5%、23.8% 和 15.6%。TRG-N 阶段显示出比 ypTNM 阶段组更适合生存，这由较低的 Akaike 信息标准 (AIC) 和贝叶斯信息标准值表明。在验证队列中发现了类似的结果。多因素分析显示TRG-N分期（P =0.02）、年龄（P =0.006）和性别（P =0.005）是独立的预后因素。

结论： 

TRG-N 分期比 AJCC 新辅助治疗 (ypTNM) 分期组具有更好的预后。