Tedavi Sonrası Onkolojik Olarak Patolojik Yanıtın Değerlendirilmesi ve Tümör Regresyon Derecelendirme Sistemleri
Özet
Neoadjuvan radyoterapi, kemoterapi veya radyokemoterapi gibi kanser tedavilerinin ardından cerrahi rezeksiyon örneklerinin histopatolojik olarak incelenmesi, hastalığın seyrini öngörmede ve tedavi yanıtını belirlemede kritik bir öneme sahiptir. Patolojik değerlendirmede rezidüel kanseri tanımlamak adına geleneksel TNM sistemine ek olarak kantitatif bir yaklaşım sunan Tümör Regresyon Derecesi (TRD) sistemleri, perioperatif tedaviye verilen yanıtı ölçen değerli bir morfolojik parametredir. Bu sistemler, tedavi sonrasında tümör yatağında meydana gelen sitoplazmik vakuolizasyon, nükleer atipi ve nekroz gibi hücresel değişimler ile fibrozis ve inflamasyon gibi stromal dönüşümleri mikroskobik düzeyde derecelendirir. Literatürde rezidüel tümör miktarı ve fibrozis ilişkisini esas alan Mandard, Ryan (AJCC/CAP), Dworak, Becker ve Rödel gibi farklı katmanlara sahip çeşitli TRD skorlama modelleri bulunmakta, bunların tercihi coğrafi bölgelere ve tümör tiplerine göre değişiklik göstermektedir. Özellikle gastrointestinal sistem malignitelerinde neoadjuvan tedavi sonrası tam veya kısmi regresyon saptanması, hasta sağkalımıyla doğrudan ve olumlu bir şekilde ilişkilidir. Sonuç olarak, tedavi etkinliğinin doğru analiz edilmesi ve gelecekte evrensel bir değerlendirme standardının yakalanabilmesi için TRD verilerinin patoloji raporlarında standart ve titiz bir şekilde yer alması, klinik yönetim açısından büyük bir gerekliliktir.
The histopathological examination of surgical resection specimens following cancer treatment modalities such as neoadjuvant radiotherapy, chemotherapy, or radiochemotherapy plays a pivotal role in predicting disease prognosis and evaluating therapeutic efficacy. Beyond the conventional TNM classification, Tumor Regression Grading (TRG) systems offer a valuable quantitative and morphological approach to assessing residual cancer by measuring the direct impact of perioperative treatments. These systems objectively categorize therapy-induced microscopic alterations, capturing cellular changes like cytoplasmic vacuolation, nuclear atypia, and necrosis, alongside stromal responses such as extensive fibrosis and inflammation. Various TRG grading models, including Mandard, Ryan (AJCC/CAP), Dworak, Becker, and Rödel, utilize distinct criteria based on the estimated percentage of residual viable tumor or the tumor-to-fibrosis ratio, with clinical preferences varying globally by geographic region and tumor type. Achieving partial or complete pathological tumor regression following neoadjuvant protocols is strongly correlated with superior patient survival outcomes, particularly within gastrointestinal malignancies. Ultimately, the meticulous inclusion of standardized TRG parameters in pathology reports is essential for delivering robust prognostic insights, optimizing multidisciplinary post-operative clinical management, and establishing a unified, universal standard for oncological evaluation in future therapeutic research.
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