摘要随着新辅助化疗及转化治疗越来越普遍地应用于胃癌的规范化治疗中,利用有效的方法对其疗效进行准确评价显得尤为重要.病理学肿瘤退缩分级(TRG)评估系统主要是观察肿瘤组织的纤维化程度以及肿瘤细胞残存的比例,是对新辅助化疗后手术切除的肿瘤进行组织病理形态学评价的重要分级标准,能够对患者的疗效和生存预测提供重要依据,在临床后续治疗决策及预后判断上能够起关键作用.目前可用于原发性胃癌新辅助化疗或转化治疗疗效评估的TRG标准有Becker、Mandard、Ninomiya及Ryan等4种标准,应用最为广泛的TRG分级标准是Ryan的0～3级分类法.我们认为,影响胃癌术后病理学TRG评估结果的主要因素有肿瘤的定位、标本的大体观察和取材、镜下评估以及过于复杂、难以操作的TRG评估标准.虽然有研究发现,胃癌新辅助化疗患者术后的肿瘤退缩程度可能与某些分子标志物相关联,但是,如果深入研究能进一步找到特异性的生物标志物,以便在内镜活检的阶段就能对胃癌新辅助化疗及转化治疗的疗效进行预估的话,可能会对临床医生治疗方案的选择及预后判断带来更大的益处.

abstractsAs the perioperative chemotherapy and conversion therapy has been widely implemented on the standard treatment of gastric cancer patients , it is of great importance to evaluate the efficacy of these patients accurately by effective methods. Being an important grading standard for histomorphological evaluation of excision specimens after neoadjuvant chemotherapy, pathological tumor regression grade (TRG) system is mainly used to assess the degree of fibrosis of tumor tissue and the proportion of residual tumor cells. TRG evaluation may provide important information referring to clinical decision making and prognostic judgment, and may imply on different efficacy and survival rates. Currently , four TRG standards can be used to evaluate the efficacy of neoadjuvant chemotherapy or translational therapy for primary gastric cancer, including Becker, Mandard, Ninomiya and Ryan, among which Ryan's 0-3 classification system is the most widely used. The main factors influencing the outcome of postoperative pathological TRG evaluation of gastric cancer include tumor localization, macroscopic observation and dissection of specimens, microscopic evaluation, as well as TRG evaluation criteria that are too complicated and difficult to operate. Although some studies have found that tumor regression of gastric cancer may be associated with some molecular markers, it may bring greater benefits to the choice of treatment decisions and prognosis judgment if further studies can confirm that specific biomarkers can help estimate the efficacy of neoadjuvant chemotherapy and translational therapy for gastric cancer after endoscopic biopsy.