Tumor budding and evidence-based treatment of T2 rectal carcinomas
Tumor budding and evidence-based treatment of T2 rectal carcinomas
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DOI：
10.1002/jso.20369
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发表时间：
2005-10-01
影响因子：
2.5
通讯作者：
Atomi, Y
中科院分区：
文献类型：
--
作者：
Masaki, T;Matsuoka, H;Atomi, Y
背景：对T2直肠癌局部切除后再行肠切除的组织学标准的有效性提出质疑。方法：统计分析72例T2直肠癌大手术切除后淋巴结转移与临床病理参数的关系，建立淋巴结转移的预测公式，并进行决策分析。结果：多因素分析显示，女性和肿瘤萌芽数目与淋巴结转移显著相关。其发生概率为：Z=0.037 x(萌芽数)+2.08 x(性别；雄性，1；雌性，2)-5.736；概率=1/1+e(-Z)。当一名75岁的患者出现肺部并发症时，手术风险被假定为超过2%。如果肿瘤萌发的数量为0，则男性患者发生LNM的风险为2.4%，女性患者为17.1%。假设T2直肠癌肝转移风险为LNM的一半，LNM和肝转移后的存活率分别为20%和50%，则男性患者的观察策略是合理的，而女性患者则应进行额外的手术治疗。结论：T2直肠癌的个体化治疗应考虑肿瘤萌发的个体化。
Background: The validity of the histological criteria in deciding additional bowel resection after local excision of T2 rectal carcinomas is questioned.Methodology: In 72 T2 colorectal carcinomas resected by major surgery, the associations between lymph node metastasis (LNM) and clinicopathologic parameters were examined statistically, a prediction formula for LNM was constructed and decision analysis was attempted.Results: Multivariate analysis showed that female gender and a greater number of tumor budding were significantly associated with LNM. The probability of LNM can be calculated as follows; Z = 0.037 x (budding number) + 2.08 x (SEX; male, 1; female, 2) - 5.736; Probability = 1/1 + e(-Z). When a 75-year-old patient has pulmonary complications, the operative risk is assumed to be over 2%. If a number of tumor budding is 0, the risk of LNM is calculated as 2.4% in a male and 17.1% in a female patient. On the assumption that the risk of liver metastasis is half of that of LNM, and the salvageabilities after LNM and liver metastasis are 20% and 50%, respectively, observation policy is justified for a male patient, whereas additional surgery should be undertaken for a female patient.Conclusions: A number of tumor budding may be useful for determining the individualized treatment of T2 rectal carcinomas.