新辅助治疗后胃肠道癌肿瘤消退分级的不同做法：一项国际调查的结果。,Modern Pathology

对新辅助治疗的胃肠道癌切除术常规进行肿瘤消退分级。肿瘤消退分级的挑战包括总收入标准、多个分级系统以及难以解释治疗引起的变化。我们调查了世界各地的胃肠道病理学家，了解他们处理新辅助治疗的胃肠道癌症标本和使用 23 个问题的在线调查报告肿瘤消退的做法。主题涉及总收入、组织学检查、肿瘤消退分级系统，以及在治疗效果内识别和估计残留癌症的难度。收到了 203 份答复，其中 173 名参与者完成了整个问卷调查。50% 的参与者来自欧洲，29% 来自北美，10% 来自澳大利亚，11% 来自其他大陆。95% 的患者定期报告肿瘤消退等级，92% 的患者进行了标准化的肉眼检查和组织学检查：27% 的患者总是完全包埋整个肿瘤床，54% 的患者包埋了完整的肿瘤部位（如果不是明显的大肿块）。59% 的人单独使用苏木精和伊红进行评估；其余使用额外的污渍。在北美和澳大利亚，美国癌症联合委员会 (AJCC)/美国病理学家学会 (CAP)/Ryan 系统常规用于胃食管癌 (71%) 和直肠癌 (77%)。在欧洲，Mandard 系统常见于胃食管肿瘤（36%），其次是 AJCC/CAP/Ryan（22%）和 Becker（10%）；对于直肠 CA，Dworak 系统 (30%) 之后是 AJCC/CAP/Ryan (24%) 和 Mandard (14%)。这种区域差异显着（p  < 0.001 每个）。百分之五十一的人更喜欢四层系统。66% 的人认为淋巴结的退化变化应该是退化等级的一部分。69% 的人认为可以直接识别残留肿瘤，但很难估计治疗引起的纤维化 (57%)。免费评论提出了检查和临床相关性的成本问题。总之，这项跨国调查提供了关于胃肠道癌症肿瘤消退分级的肉眼和组织学检查的全面概述，具有部分显着的区域差异，尤其是在北美和欧洲之间。

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Tumor regression grading is routinely performed on neoadjuvantly treated gastrointestinal cancer resections. Challenges in tumor regression grading include grossing standards, multiple grading systems, and difficulty interpreting therapy-induced changes. We surveyed gastrointestinal pathologists around the world for their practices in handling neoadjuvantly treated gastrointestinal cancer specimens and reporting tumor regression using a 23-question online survey. Topics addressed grossing, histologic work-up, tumor regression grading systems, and degree of difficulty identifying and estimating residual cancer within treatment effect. Two-hundred three responses were received, including 173 participants who completed the entire questionnaire. Fifty percent of the participants were from Europe, 29% from North America, 10% from Australia, and 11% from other continents. Ninety-five percent routinely report a tumor regression grade and 92% have standardized grossing and histologic work-up: 27% always completely embed the entire tumor bed, 54% embed the complete tumor site if not a grossly apparent, large mass. Fifty-nine percent use hematoxylin & eosin alone for assessment; the remaining use additional stains. In North America and Australia, the American Joint Committee on Cancer (AJCC)/College of American Pathologists (CAP)/Ryan system is routinely used for gastroesophageal (71%) and rectal carcinomas (77%). In Europe, the Mandard system is common (36%) for gastroesophageal tumors, followed by AJCC/CAP/Ryan (22%), and Becker (10%); for rectal CA, the Dworak system (30%) is followed by AJCC/CAP/Ryan (24%) and Mandard (14%). This regional differences were significant (p