Growth pattern in the muscular layer reflects the biological behaviour of colorectal cancer
Growth pattern in the muscular layer reflects the biological behaviour of colorectal cancer
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DOI：
10.1111/j.1463-1318.2008.01718.x
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发表时间：
2009-11-01
影响因子：
3.4
通讯作者：
Mochizuki, H.
中科院分区：
文献类型：
--
作者：
Ueno, H.;Hase, K.;Mochizuki, H.
目的探讨固有肌层（MP）肿瘤形态学对结直肠癌（CRC）的诊断价值。（i）环形和纵向肌肉层之间的水平扩展（H-传播）和（ii）环形肌肉层的肌束之间的“流”传播结果153例H-播散和150例S-播散与肿瘤淋巴结转移（TNM）呈正相关分期均对术后生存率产生负面影响。MP的不良形态（H型和/或S型扩散）与高级别的血管浸润和壁外层出芽一致，也与反应性纤维区的不良纤维化基质一致;具有这些特征的患者的5年生存率为64.2%，低于无这些特征的患者（86.5%，P < 0.0001）。多因素分析表明，不良形态学是一个独立的预后决定因素，沿着T-和N -阶段。作为H-传播的模式，肌间神经丛的神经浸润被认为是占主导地位的淋巴蔓延的基础上的S100和CD 34免疫染色，但神经细胞粘附分子的表达，无论是对癌细胞或神经细胞，是不显着的这种增长pattern.ConclusionA特定组的CRCs巧妙地利用薄的空间之间的肌束的发展在MP。虽然其生物学机制尚不清楚，但这种独特的生长模式可能是识别高复发风险CRC患者的有用指标。
ObjectiveTo determine the clinical value of evaluating the cancer morphology in muscularis propria (MP) for colorectal cancer (CRC) patients.MethodA total of 994 patients with advanced CRC were reviewed in terms of two distinctive growth patterns in the MP: (i) horizontal spread between the circular and longitudinal muscle layers (H-spread) and (ii) 'streaming' spread between the muscle bundles of the circular muscle layer (S-spread).ResultsThe incidence of H-spread (n = 153) and S-spread (n = 150) showed a positive correlation with tumour-node-metastasis (TNM) stage and both exerted a negative impact on postoperative survival. Adverse morphology in the MP (H-spread and/or S-spread) was consistent with a high grade of vascular invasion and budding in the extramural layer, as also with unfavourable fibrotic stromas in the reactive fibrous zone; the 5-year survival rate in patients with such features was 64.2%, which was lower than that in those without (86.5%, P < 0.0001). Multivariate analysis demonstrated that adverse morphology was an independent prognostic determinant, along with T- and N -stage. As the mode of H-spread, perineural invasion in the myenteric plexus was found to be predominant over lymphatic spread on the basis of S100 and CD34 immunostaining, but neural cell adhesion molecule expression, whether on cancer cells or on neural cells, was not significant for this growth pattern.ConclusionA particular group of CRCs ingeniously utilizes the thin space between muscle fascicles for development in the MP. Although the biological mechanism remains unknown, this distinctive growth pattern could be a useful indicator to identify CRC patients at high risk of recurrence.