Tumour budding at invasive margins and outcome in colorectal cancer
Tumour budding at invasive margins and outcome in colorectal cancer
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DOI：
10.1111/j.1463-1318.2007.01240.x
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发表时间：
2008-01-01
影响因子：
3.4
通讯作者：
Watanabe, M.
中科院分区：
文献类型：
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作者：
Kanazawa, H.;Mitomi, H.;Watanabe, M.
目的肿瘤出芽是指在肿瘤浸润边缘聚集的未分化癌细胞，它反映了大肠癌的生物学侵袭性。因此，我们研究的预后意义的肿瘤出芽在结直肠癌患者，特别是专注于与其他临床病理findings.Method肿瘤出芽的比较进行了研究，从159例结直肠癌手术切除标本。根据肿瘤浸润范围，将肿瘤芽殖程度分为轻度（<1/3）、中度（1/3-2/3）和显著（> 2/3）3级。结果轻度54例（34%），中度59例（37%），显著46例（29%）。芽殖程度与肿瘤分化程度、淋巴结转移及TNM分期有关（P <0.001）。在单变量分析中，具有明显肿瘤萌芽的患者[5年癌症相关生存率（CRS）/无复发生存率（RFS），39%/53%]的生存率显著更差[CRS，风险比（HR），4.561; 95%置信区间（CI），2.265 - 9.184; P <0.001; RFS，HR，3.240; 95%CI，1.430 - 7.342; P = 0.005]，而轻度（5年CRS/RFS，80%/82%）或中度（63%/66%）出芽的患者。在考克斯回归模型中，显著的肿瘤萌芽（HR，3.137; 95% CI，1.517 - 6.487; P = 0.002）和晚期肿瘤分期（III期HR为3.226; 95% CI为1.475 - 7.053; P = 0.003; IV期HR为24.443; 95% CI为10.843 - 55.100; P <0.001），但不影响正常工作。结论肿瘤出芽是鉴别高度恶性肿瘤的一个实用而有意义的组织学指标结直肠癌患者的潜在和不良结局。
Objective Tumour budding, defined as small clusters of undifferentiated cancer cells at invasive margins, has been shown to reflect biologic aggressiveness of colorectal cancers. We therefore examined the prognostic significance of tumour budding in patients with colorectal carcinoma, particularly focusing on comparisons with other clinicopathological findings.Method Tumour budding was investigated in surgically resected specimens from 159 patients with colorectal carcinoma. With haematoxylin and eosin stained slides containing the entire invasive margin, the degree of tumour budding was classified into three grades: mild, < 1/3 of the entire invasive margin; moderate, 1/3-2/3; marked, > 2/3.Results Mild tumour budding was found in 54 (34%) cases, moderate in 59 (37%) cases and marked in 46 (29%) cases. The degree of budding was linked with poor tumour differentiation, lymph node metastasis and advanced TNM stage (P < 0.001). In univariate analysis, patients with marked tumour budding [5-year cancer-related survival (CRS)/recurrence-free survival (RFS), 39%/53%] had significantly worse survival [CRS, hazard ratio (HR), 4.561; 95% confidence interval (CI), 2.265-9.184; P < 0.001; RFS, HR, 3.240; 95% CI, 1.430-7.342; P = 0.005] than those with mild (5-year CRS/RFS, 80%/82%) or moderate (63%/66%) budding. In the Cox regression model, marked tumour budding (HR, 3.137; 95% CI, 1.517-6.487; P = 0.002) and advanced tumour stage (stage III, HR, 3.226; 95% CI, 1.475-7.053; P = 0.003; stage IV, HR, 24.443; 95% CI, 10.843-55.100; P < 0.001) proved to be an independent predictor of short CRS.Conclusion Tumour budding is a practical and significant histological index for identification of high malignant potential and poor outcome in patients with colorectal carcinoma.