新辅助治疗转移性黑色素瘤切除标本的病理评估。
Pathological assessment of resection specimens after neoadjuvant therapy for metastatic melanoma.
机构信息
Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, USA; Department of Translational and Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, USA.
Departments of Anatomic Pathology and Cutaneous Oncology, Moffitt Cancer Center, Tampa, USA.
出版信息
Ann Oncol. 2018 Aug 1;29(8):1861-1868. doi: 10.1093/annonc/mdy226.
BACKGROUND
Clinical trials have recently evaluated safety and efficacy of neoadjuvant therapy among patients with surgically resectable regional melanoma metastases. To capture informative prognostic data connected to pathological response in such trials, it is critical to standardize pathologic assessment and reporting of tumor response after this treatment.
METHODS
The International Neoadjuvant Melanoma Consortium meetings in 2016 and 2017 assembled pathologists from academic centers to develop consensus guidelines for pathologic examination and reporting of surgical specimens from AJCC (8th edition) stage IIIB/C/D or oligometastatic stage IV melanoma patients treated with neoadjuvant-targeted or immune therapy. Patterns of pathologic response are provided context to inform these guidelines.
RESULTS
Based on our collective experience and guided by efforts in well-established neoadjuvant settings like breast cancer, procedures directing handling of pre- and post-neoadjuvant therapy-treated melanoma specimens are provided to facilitate comparison of findings across different trials and centers. Definitions of pathologic response are provided together with guidelines for reporting and quantifying the extent of pathologic response. Finally, the spectrum of histopathologic responses observed following neoadjuvant-targeted and immune-checkpoint therapy is described and illustrated.
CONCLUSIONS
Standardizing pathologic evaluation of resected melanoma metastases following neoadjuvant-targeted or immune-checkpoint therapy allows more robust stratification of patient outcomes. This includes recognizing the spectrum of histopathologic response patterns to neoadjuvant therapy and a standard approach to grading pathologic responses. Such an approach will facilitate comparison of results across clinical trials and inform ongoing correlative studies into the mechanisms of response and resistance to agents applied in the neoadjuvant setting.
背景
最近的临床试验评估了新辅助治疗在可手术切除的局部黑色素瘤转移患者中的安全性和疗效。为了在这些试验中获取与病理反应相关的有意义的预后数据，标准化肿瘤反应的病理评估和报告对于新辅助治疗后病理评估和报告至关重要。
方法
2016 年和 2017 年，国际新辅助黑色素瘤联合会召集了来自学术中心的病理学家，制定了 AJCC（第 8 版）IIIb/c/d 期或寡转移 IV 期黑色素瘤患者接受新辅助靶向或免疫治疗后手术标本的病理检查和报告共识指南。病理反应模式为这些指南提供了背景信息。
结果
基于我们的集体经验，并借鉴了乳腺癌等成熟新辅助环境中的努力，提供了指导处理新辅助治疗前后黑色素瘤标本的程序，以促进不同试验和中心之间的结果比较。提供了病理反应的定义，并制定了报告和量化病理反应程度的指南。最后，描述并说明了新辅助靶向和免疫检查点治疗后观察到的组织病理学反应谱。
结论
标准化新辅助靶向或免疫检查点治疗后切除的黑色素瘤转移的病理评估允许更有力地分层患者的结局。这包括识别新辅助治疗的组织病理学反应模式谱和病理反应分级的标准方法。这种方法将促进临床试验结果的比较，并为新辅助环境中应用药物的反应和耐药机制的相关研究提供信息。
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