The grading and prognosis of carcinoma of the colon and rectum
The grading and prognosis of carcinoma of the colon and rectum
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DOI：
10.1097/00000658-193904000-00002
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发表时间：
1939-01-01
影响因子：
9
通讯作者：
Grinnell, RS
中科院分区：
文献类型：
--
作者：
Grinnell, RS
自1893年冯·汉斯曼首次尝试通过肿瘤的组织学来对肿瘤的恶性程度进行分级以来，许多病理学家对各种肿瘤进行了类似的研究。大多数人都同意分级对预后有一定的价值，但不同意有多大价值。其他人则认为这没有任何意义。结肠和直肠肿瘤的研究主要由兰金和Broders，2兰金，3兰金和Olson，4 Dukes，5 6 Stewart和Spies，7 Wood和Wilkie，8和雷福德进行。[9]每个人都相信分级在预后中的重要性，但并不总是使用相同的方法。兰金和Broders根据分化和未分化细胞的相对比例将肿瘤分为4级。公爵们也使用这种方法。Stewart和Spies根据有丝分裂的数量、乳头状突起形成的数量、细胞及其核的极性保持的程度以及腺样体结构的保存情况进行分级。伍德和威尔基采用了类似的方法，主要基于低倍放大，但显然没有使用有丝分裂的频率作为标准。MacCarty主张根据间质的变化，如淋巴细胞浸润、纤维化和玻璃样变，采用其他标准。其他病理学家还使用其他方法来估计肿瘤的恶性程度。在最近对一系列乳腺癌的研究中，哈根森首次试图从统计学上确定所用各种标准的价值。共研究了15个，涉及细胞生长的差异、细胞形态的差异和基质反应的差异。其中6例被发现具有预后意义，并用于确定其系列中肿瘤的等级。这些标准包括乳头状结构、粉刺特征、腺样排列、核大小和形状的变化、有丝分裂的数量和凝胶样变性。当然，对乳腺癌有价值的标准不一定适用于其他类型。对于每一种肿瘤，都应该通过Haagensen的研究来重新确定。在本系列中，我们已经尝试了这一点。这一系列包括从1916年至1932年（含）长老会医院收治的所有结肠癌和直肠癌病例，这些病例在预期患者可能治愈的情况下进行了切除，并且在这些病例中可以获得显微切片。1938年9月27日出版。500
SINCE I893, when Von Hansemann'first attempted to grade the malignancy of tumors by their histology, many pathologists have made similar studies on all varieties of tumors. Most have agreed that grading is of some value in prognosis, but have disagreed as to how much. Others have not found it of any significance. Studies on colon and rectal tumors have been made chiefly by Rankin and Broders, 2 Rankin, 3 Rankin and Olson, 4 Dukes, 5 6 Stewart and Spies, 7 Wood and Wilkie, 8 and Raiford. 9 Each was convinced of the importance of grading in prognosis, but did not always use the same method. Rankin and Broders divided the tumors into four grades according to the relative proportion of differentiated and undifferentiated cells. Dukes used this method also. Stewart and Spies based their grades on the number of mitoses, the amount of papillary formation, the degree to which the polarity of the cells and their nuclei had been maintained, and the preservation of adenoid structure. Wood and Wilkie adopted a similar method, based mainly on low power magnification, but apparently did not use the frequency of mitosis as a criterion. MacCarty'0 advocated other criteria, based on changes in the stroma, such as lymphocytic infiltration, fibrosis, and hyalinization. Other pathologists have used still other methods for estimating the malignancy of tumors. In a recent study of a series of carcinomata of the breast, Haagensen1'has, for the first time, attempted to determine statistically the value of the various criteria used. Fifteen in all were studied, involving differences in thegrowth of cells, differences in cellmorphology, and differences in the reaction of the stroma. Six were found to have prognostic significance and were used to determine the grades of the tumors in his series. These criteria were the papillary structure, comedo character, adenoid arrangement, variations in size and shape of the nuclei, the number of mitoses, and gelatinous degeneration. Of course, criteria which are of value in breast cancer are not necessarily suitable to apply to other types. Ineach type of tumor, they should be redetermined by such a study as Haagensen has made. In the present series, this has been attempted. This series includes all the cases of carcinoma of the colon and rectum admitted to the Presbyterian Hospital from I9I6 to I932, inclusive, upon whom a resection had been performed with the expectancy of possible cure of the patient and in which cases microscopic sections were available. Both Submitted for publication September 27, I938. 500