Role of desmoplasia in recurrence of stage II colorectal cancer within five years after surgery and therapeutic implication
Role of desmoplasia in recurrence of stage II colorectal cancer within five years after surgery and therapeutic implication
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DOI：
10.1080/07357900701788155
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发表时间：
2008-01-01
影响因子：
2.4
通讯作者：
Paoluzi, Paolo
中科院分区：
文献类型：
--
作者：
Crispino, Pietro;De Toma, Giorgio;Paoluzi, Paolo
背景资料：结直肠癌（CRC）转移在静脉栓塞患者中增强，增加复发风险，因此增加死亡率。一些证据表明，II期患者在手术后五年内会突然复发。这一事实促使我们研究不同组织学变量对CRC侵袭性的作用。目的：证明定量和定性促结缔组织增生反应和淋巴细胞浸润是否是手术后5年内CRC复发的预后因素，考虑可能的临床和治疗意义。方法：34例结直肠癌患者均行结肠切除术，采用UICC-TNM分期。半定量评价组织学变量。用苏木精-伊红法对结缔组织增生进行定性评价。结果：随访5年，II期患者的生存率提高到88%，12%未接受辅助化疗的患者发生转移。结缔组织增生与静脉肿瘤侵袭密切相关（OR：21.93; 95%CI：1.012-475.26，p = 0.02），因此与死亡率密切相关（OR：14.33; 95%CI：0.67-304，p = 0.04）。此外，与成熟间质组织相比，未成熟结缔组织增生患者的死亡率显著更高（OR：15.61，95%CI：0.69-343.38，p = 0.04）。结论：这些观察结果应促使未来的评价结缔组织增生的程度更适合使用辅助化疗的II期患者。需要进一步的临床试验来确定这些发现是否能够降低II期CRC患者的死亡率。
Background: Colorectal cancer (CRC) metastasis is enhanced in patients with venous embolization increasing the risk of recurrence and therefore mortality rate. Several evidences indicate that stage II patients have an abrupt recurrence within five years from surgery. This fact, led us to investigate the role played by different histological variables on CRC invasiveness. Aim: To demonstrate if quantitative and qualitative desmoplastic response and lymphocytic infiltration are prognostic factor involved in the recurrence of CRC within five years from surgery, considering possible clinical and therapeutical implications. Methods: Thirty-four patients with CRC underwent colectomy and the UICC-TNM classification was applied for disease staging. Histological variables were semi-quantitatively evaluted. Qualitative evaluation of desmoplasia was obtained with the hematoxillin-eosin method. Results: Survival rate arose 88% at stage II, at five years of follow-up, and the 12% not treated with adiuvant chemotherapy developed metastasis. Desmoplasia is strongly associated with venous neoplastic invasiveness (OR: 21.93; 95%CI: 1.012-475.26, p = 0.02), and therefore, with mortality rate (OR: 14.33; 95%CI: 0.67-304, p = 0.04). Moreover, mortality rate was significantly higher in patients with immature desmoplasia compare to mature stromal tissue (OR: 15.61, 95%CI: 0.69-343.38, p = 0.04). Conclusions: These observations should prompt a future evaluation of desmoplasia to extent more suitably the use of adjuvant chemotherapy in II stage patients. Further clinical trials are needed to determine if these findings will be able to reduce mortality rate, in stage II CRC patients.