Tumor budding as a prognostic marker in stage-III rectal carcinoma
Tumor budding as a prognostic marker in stage-III rectal carcinoma
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DOI：
10.1007/s00384-006-0249-8
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发表时间：
2007-08-01
影响因子：
2.8
通讯作者：
Lee, Hyung-Sik
中科院分区：
文献类型：
--
作者：
Choi, Hong-Jo;Park, Ki-Jae;Lee, Hyung-Sik
背景与目的肿瘤沿浸润缘萌发与结直肠癌的生物学行为有关。本研究的目的是探讨半定量评估直肠癌中肿瘤出芽是否与肿瘤行为相关，并评估肿瘤出芽是否可作为区分高恶性潜能肿瘤与低恶性潜能肿瘤的病理参数，用于预后分层。材料与方法收集244例高分化或中分化直肠癌的手术标本，评估肿瘤浸润边缘的芽肿强度。根据四分位数将强度半定量地分为四组，并分析5年无病生存（DFS）以寻找预后分层的截止点。结果将患者划分为不同DFS亚组的最佳指标的强度截止值在四分位数3和四分位数4之间，但该截止值两侧亚组的生存差异仅在iii期疾病中具有显著性[5年DFS， 62.1 vs 35.1%；p = 0.0023;95%可信区间（CI）， 0.1824-0.6919]。多因素分析表明，出芽强度是与DFS相关的自变量（风险比2.005;p=0.0086; 95% CI 1.021 ~ 3.934）。当对出芽分级（低，0；高，1）和III期N分期（N1, 0; N2, 1）进行评分时，5年DFS的预后分层优于美国癌症淋巴结分期联合委员会（0 vs 1 vs 2, 66.5 vs 42.6 vs 29.2%; p=0.0101）。结论定量评估肿瘤出芽是鉴别高恶性潜能的可靠生物学预后指标。采用肿瘤出芽和N分期评分系统对iii期直肠癌的预后有较好的分层效果。前瞻性评估将证实肿瘤萌芽对预后分层的临床意义。
Background and aims Tumor budding along the invasive margin is known to be associated with biological behavior in colorectal carcinoma. The aims of this study were to explore if the semiquantitative assessment of tumor budding in rectal cancers correlates with oncological behavior and to appraise if the tumor budding is valid as a pathological parameter in distinguishing tumors with higher malignancy potential from those with lower one for prognostic stratification.Materials and methods Surgical specimens from 244 patients with well- or moderately differentiated rectal carcinoma were retrieved to assess the intensity of tumor budding at the invasive margin. Intensities were divided semiquantitatively into four groups based on quartiles, and the 5-year disease-free survivals (DFS) were analyzed to search for a cutoff point of prognostic stratification.Results The cutoff of the intensity considered to be the best indicator for dividing patients into subgroups with different DFS was between quartiles 3 and 4, but this survival difference in subgroups in either side of the cutoff was significant only in stage-III disease [5-year DFS, 62.1 vs 35.1%; p=0.0023; 95% confidence interval (CI), 0.1824-0.6919]. Based on multivariate analysis, the intensity of budding proved to be an independent variable associated with DFS (hazard ratio, 2.005; p=0.0086; 95% CI, 1.021-3.934). When scores were given to grade of budding (lower, 0; higher, 1) and N stage (N1, 0; N2, 1) in stage III, a better prognostic stratification in terms of the 5-year DFS was obtained than the American Joint Committee on Cancer nodal staging only (0 vs 1 vs 2, 66.5 vs 42.6 vs 29.2%; p=0.0101).Conclusions Quantitative assessment of tumor budding is a reliable biological prognostic variable to identify higher malignancy potential. Scoring system using tumor budding and N stage showed better prognostic stratification in stage-III rectal carcinoma. A prospective evaluation would confirm the clinical significance of tumor budding for prognostic stratification.