PROGNOSTIC VALUE OF TUMOR BUDDING IN PATIENTS WITH COLORECTAL-CANCER
PROGNOSTIC VALUE OF TUMOR BUDDING IN PATIENTS WITH COLORECTAL-CANCER
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DOI：
10.1007/bf02238588
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发表时间：
1993-07-01
影响因子：
3.9
通讯作者：
VIERRA, M
中科院分区：
文献类型：
--
作者：
HASE, K;SHATNEY, C;VIERRA, M
1970年至1985年，663例结直肠癌根治性切除术。所有的手术标本都被检查了肿瘤的“萌芽”，它被定义为在病变的浸润性前沿前面有一小群未分化的癌细胞。根据出芽程度将患者分为两组：无或轻度(BD-1)和中度或重度(BD-2)。BD-1 493例(74.4%)，BD-2 170例(25.6%)。更严重的萌芽与更糟糕的结果相关：BD-2患者中71.1%的患者复发，而BD-1患者的这一比例为20.0%(P<；0.005)。BD-2的五年存活率比BD-1差(22.2%比70.7%；P<；0.001)。BD-2的10年生存率也比BD-1差(13.8%比50.6%；P<；0.001)。BD-2的发生率随着Dukes分期的升高而升高。然而，有BD-2病变的DukesB期患者的五年生存率比DukesC期BD-1癌患者差(29.1%vs.66.2%；P<；0.001)。此外，在Dukes B或C病变的BD-1患者中，5年存活率没有差异(68.3%比66.2%)。更严重的萌芽的出现似乎表明结直肠癌具有强烈的生物学活性。因此，无论Dukes分期如何，细致的随访--可能还有辅助化疗--对有明显萌芽的患者可能是有益的。
From 1970 to 1985, 663 patients underwent curative resection of colon and rectal adenocarcinomas. All surgical specimens were examined for tumor ''budding,'' defined as small clusters of undifferentiated cancer cells ahead of the invasive front of the lesion. Patients were divided into two groups according to degree of budding: none or mild (BD-1) and moderate or severe (BD-2). BD-1 occurred in 493 patients (74.4 percent), and BD-2 was found in 170 patients (25.6 percent). More severe budding was associated with worse outcome: 71.1 percent of BD-2 patients had recurrence, compared with 20.0 percent of BD-1 patients (P < 0.005). The five-year survival rate was worse in BD-2 than in BD-1 (22.2 percent vs. 70.7 percent; P < 0.001). The 10-year survival rate was also worse in BD-2 than in BD-1 (13.8 percent vs. 50.6 percent; P < 0.001). The incidence of BD-2 rose with the Dukes stage. However, the five-year survival rate of Dukes B patients with BD-2 lesions was worse than that of Dukes C patients with BD-1 cancers (29.1 percent vs. 66.2 percent; P < 0.001). Moreover, there was no difference in five-year survival among BD-1 patients with either Dukes B or C lesions (68.3 percent vs. 66.2 percent). The presence of more severe budding appears to indicate a vigorous biologic activity of colorectal cancer. Thus, meticulous follow-up-and possibly adjuvant chemotherapy-may be beneficial for patients with marked budding, regardless of their Dukes stage.