Medullary Colorectal Carcinoma Revisited: A Clinical and Pathological Study of 102 Cases
Medullary Colorectal Carcinoma Revisited: A Clinical and Pathological Study of 102 Cases
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DOI：
10.1245/s10434-014-4355-5
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发表时间：
2015-09-01
影响因子：
3.7
通讯作者：
Gill, Anthony J.
中科院分区：
文献类型：
--
作者：
Knox, Robert D.;Luey, Nathan;Gill, Anthony J.
髓样癌是近年来发现的错配修复缺陷型结直肠癌的一种亚型，尽管传统形态学诊断其分化较差，但据报道其预后良好。我们研究了一个接受手术切除的CRC队列中髓样CRC的病理和临床特征，对1998年至2012年在一个单一卫生区数据库中切除的所有CRC进行了前瞻性分类，并进行了回顾性分析，以确定91例髓样CRC，其中11例是2013年至2014年的病例。采用严格的标准诊断髓样癌，要求MMRd和大于90%的肿瘤表现出典型的形态学，包括实体生长。将人口统计学和病理学特征以及全因生存率与其他CRC进行比较，特别是与其他MMRd CRC进行比较。从1998年至2012年，3，295例CRC中有91例（2.8%）为髓样型。髓样结直肠癌在女性中的发生率高于男性（3.3：1; p < 0.0001）、老年人（平均年龄77岁vs. 71岁; p < 0.001）和右半结肠（86%; p < 0.0001）。所有髓样CRC均表现出MMR缺陷（被视为入选标准），86%为BRAFV 600 E突变（p < 0.0001）。髓样结直肠癌切除术后30天死亡率较高（4.6% vs. 1.7%; p = 0.049）。在单变量分析中，生存率并不优于高分化或其他MMRd肿瘤。然而，使用多变量模型，髓样表型是保护性的（死亡风险比0.54，95%CI 0.30-0.96; p = 0.037）。髓样CRC比以前报道的更常见，经常表现为局部晚期疾病，并且可能与切除后30天的较高死亡率相关。尽管如此，当使用严格的诊断标准时，与具有相同人口统计学和病理学特征的CRC相比，总生存率是有利的。
Medullary carcinoma is a recently described subtype of mismatch repair deficient (MMRd) colorectal carcinoma (CRC) which, despite being poorly differentiated by traditional morphological criteria, has been reported to have a good prognosis. We investigated the pathological and clinical features of medullary CRC in an unselected cohort of CRCs undergoing surgical resection.All CRCs resected within a single health district database from 1998 to 2012 were categorized prospectively and underwent retrospective review to identify 91 medullary CRCs, with 11 additional cases from 2013 to 2014. Strict criteria were employed to diagnose medullary carcinoma requiring both MMRd and greater than 90 % of the tumor to demonstrate typical morphology, including solid growth. The demographic and pathological features, as well as all-cause survival, were compared with other CRCs, and specifically to other MMRd CRCs.From 1998 to 2012, 91 of 3,295 CRCs (2.8 %) were of the medullary type. Medullary CRC was more likely to arise in females than males (3.3:1; p < 0.0001), the elderly (mean age 77 vs. 71 years; p < 0.001), and the right colon (86 %; p < 0.0001). All medullary CRCs demonstrated MMR deficiency (considered an inclusion criteria) and 86 % were BRAFV600E-mutated (p < 0.0001). Thirty-day mortality after resection was higher in medullary CRC (4.6 vs. 1.7 %; p = 0.049). On univariate analysis, survival was not better than well-differentiated or other MMRd tumors. However, using a multivariate model, a medullary phenotype was protective (hazard ratio of death 0.54, 95 % CI 0.30-0.96; p = 0.037).Medullary CRC is more common than previously reported, frequently presents with locally advanced disease, and may be associated with higher mortality at 30 days after resection. Despite this, when strict criteria are used for diagnosis, the overall survival is favorable when compared with CRCs with equivalent demographic and pathological characteristics.