Rektum Kanserinde Mandard Tümör Regresyon Skorunun Prognostik Değeri: Neoadjuvan Tedavi Sonrası Histopatolojik Parametreler ve Sağkalım ile İlişkisi

Öz

Rektum kanserinde neoadjuvan kemoradyoterapi sonrası tümör yanıtının değerlendirilmesi, tedavi başarısı, prognoz ve adjuvan tedavi kararlarının belirlenmesinde temel rol oynar. Mandard tümör regresyon skoru (TRG), bu süreçte yaygın olarak kullanılan histopatolojik bir değerlendirme yöntemidir. Bu çalışmada Mandard TRG’nin, histopatolojik parametrelerle ilişkisi ve sağkalım üzerindeki prognostik değeri araştırılmıştır. 2020–2025 yılları arasında neoadjuvan tedavi sonrası cerrahi uygulanan 60 rektum kanseri hastasının verileri retrospektif olarak incelenmiştir. TRG üçlü sınıflama ile (TRG 1: tam yanıt, TRG 2: kısmi yanıt, TRG 3: yanıtsız) değerlendirilmiş; cerrahi sınır durumu, lenfovasküler invazyon, perinöral invazyon, lenf nodu durumu ve sağkalım süresi ile ilişkisi analiz edilmiştir. TRG 3 grubunda mortalite oranı anlamlı şekilde yüksek bulunmuş (p=0,008) ve bu grup; lenfovasküler invazyon, perinöral invazyon, pozitif cerrahi sınır ve ileri evre tümör ile anlamlı ilişki göstermiştir. Kaplan-Meier analizinde yanıtlı gruptaki (TRG 1-2) hastaların ortalama sağkalım süresi belirgin şekilde daha uzun saptanmıştır (56,7 ay vs. 36,1 ay; p=0,010). Çok değişkenli analizde, TRG ile belirlenen yanıt durumu sağkalımı etkileyen sınırda anlamlı tek değişken olarak saptanmıştır (p=0,057). Mandard TRG, neoadjuvan tedavi sonrası rektal kanser hastalarında yalnızca tedavi yanıtını değil, aynı zamanda sağkalımı öngörebilen prognostik bir araçtır. TRG’nin adjuvan tedavi kararları ve takip stratejilerinde yönlendirici olarak kullanımı, kişiselleştirilmiş onkolojik yaklaşım için önemli katkılar sağlayabilir.

Anahtar Kelimeler

• rektum kanseri
• Mandard tümör regresyon skoru
• neoadjuvan tedavi
• sağkalım

Prognostic Value of Mandard Tumor Regression Grade in Rectal Cancer: Association with Histopathological Parameters and Survival Following Neoadjuvant Therapy

Öz

In rectal cancer, the evaluation of tumor response after neoadjuvant chemoradiotherapy (nCRT) plays a fundamental role in determining treatment success, prognosis, and decisions regarding adjuvant therapy. The Mandard tumor regression grade (TRG) is a widely used histopathological method for assessing treatment response in this context. This study aimed to investigate the prognostic value of Mandard TRG by analyzing its relationship with histopathological parameters and overall survival. Data from 60 rectal cancer patients who underwent surgery following neoadjuvant therapy between 2020 and 2025 were retrospectively analyzed. TRG was assessed using a three-tier classification (TRG 1: complete response, TRG 2: partial response, TRG 3: no response). Associations between TRG and surgical margin status, lymphovascular invasion, perineural invasion, lymph node status, and survival duration were evaluated. The mortality rate was significantly higher in the TRG 3 group (p=0.008), which also showed significant associations with lymphovascular invasion, perineural invasion, positive surgical margins, and advanced tumor stage. According to Kaplan-Meier analysis, patients in the responder group (TRG 1–2) had a significantly longer average survival time (56.7 months vs. 36.1 months; p=0.010). In multivariate analysis, TRG-based response status was identified as the only variable with borderline statistical significance affecting survival (p=0.057). Mandard TRG is a prognostic tool that reflects not only treatment response but also overall survival in rectal cancer patients following neoadjuvant therapy. Its incorporation into adjuvant treatment decisions and follow-up strategies may contribute significantly to personalized oncologic care.

Anahtar Kelimeler

• rectal cancer
• Mandard tumor regression grade
• neoadjuvant therapy
• survival

Kaynakça

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