Prognostic significance of histological categorization of desmoplastic reaction in colorectal liver metastases
Prognostic significance of histological categorization of desmoplastic reaction in colorectal liver metastases
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DOI：
10.1007/s00428-019-02580-2
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发表时间：
2019-09-01
期刊：
影响因子：
3.5
通讯作者：
Ueno, Hideki
中科院分区：
文献类型：
--
作者：
Ao, Tadakazu;Kajiwara, Yoshiki;Ueno, Hideki
促结缔组织增生反应（DR）涉及肿瘤周围纤维或结缔组织的生长，最近作为恶性潜能的指标引起了人们的注意。以往的研究已经证实，原发肿瘤中DR的组织学分类是结直肠肝转移（CRLM）患者的独立预后因素。然而，目前还不清楚是否DR状态的转移性肝病变（DRliver）是一个有用的预后因素。本病理学回顾评价了204例在日本国防医学院医院接受肝切除术治疗CRLM的患者的记录。根据转移性肝损害中瘢痕疙瘩样胶原和粘液样基质的存在，每个病例的DR肝被分类为成熟、中间或不成熟。这导致12例成熟DR肝，101例中间DR肝和91例未成熟DR肝。原发肿瘤和转移性肝病变的DR状态之间存在显著相关性（斯皮尔曼rho = 0.3，P = 0.0001）。肝切除术后5年无复发生存率为33.8%的成熟/中期DR肝和16.7%的未成熟DR肝（P = 0.0021）。肝切除术后5年总生存率在成熟/中间型DR肝组（64.8%）高于未成熟DR肝组（35.0%; P = 0.0012）。多变量分析证实DRliver分类可以独立预测无复发生存期和总生存期。总之，DRliver分类对预测CRLM患者肝切除术后的预后可能有价值。
Desmoplastic reaction (DR) involves the growth of fibrous or connective tissues around a tumor and has recently attracted attention as an indicator of malignant potential. Previous studies have confirmed that histological categorization of DR in the primary tumor is an independent prognostic factor in patients with colorectal liver metastases (CRLM). However, it remains unclear whether the DR status of the metastatic liver lesion (DRliver) is a useful prognostic factor. This pathological review evaluated records from 204 patients who underwent hepatectomy for CRLM at the National Defense Medical College Hospital in Japan. Each case's DRliver was classified as mature, intermediate, or immature based on the presence of keloid-like collagen and myxoid stroma in the metastatic liver lesion. This resulted in 12 cases of mature DRliver, 101 cases of intermediate DRliver, and 91 cases of immature DRliver. There was a significant correlation between the DR statuses of the primary tumor and the metastatic liver lesion (Spearman's rho = 0.3, P = 0.0001). The 5-year relapse-free survival rates after hepatectomy were 33.8% for mature/intermediate DRliver and 16.7% for immature DRliver (P = 0.0021). The 5-year overall survival rate after hepatectomy was higher in the mature/intermediate DRliver group (64.8%) than in the immature DRliver group (35.0%; P = 0.0012). The multivariate analysis confirmed that DRliver categorization could independently predict relapse-free survival and overall survival. In conclusion, DRliver categorization may be valuable for predicting prognosis after hepatectomy among patients with CRLM.