Pathological assessment of pericolonic tumor deposits in advanced colonic carcinoma: relevance to prognosis and tumor staging
Pathological assessment of pericolonic tumor deposits in advanced colonic carcinoma: relevance to prognosis and tumor staging
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DOI：
10.1038/modpathol.3800791
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发表时间：
2007-08-01
期刊：
影响因子：
7.5
通讯作者：
Pelosi, Giuseppe
中科院分区：
文献类型：
--
作者：
Puppa, Giacomo;Maisonneuve, Patrick;Pelosi, Giuseppe
目前的TNM分类认为，如果结节具有不规则的轮廓，则结肠周围/直肠周围脂肪组织中的肿瘤结节为静脉侵犯，如果结节具有淋巴结的形式和光滑轮廓，则为区域淋巴结转移。然而，关于结肠周围肿瘤沉积和结旁扩散的临床病理意义的详细研究仍然缺乏。我们研究了228例晚期结肠癌患者结肠周围脂肪中这些转移性沉积物的影响。结肠周围肿瘤沉积物的特征在于它们的外观、大小、与原发肿瘤的距离以及它们与淋巴结中未组织化的淋巴组织的关系。然后将这些特征与肿瘤的临床病理特征和患者的生存率进行比较。在单变量分析中，所有这些病变都与无病生存率和总生存率降低相关，但在多变量分析中，只有结肠周围肿瘤沉积物保留了独立的预后作用。我们的研究结果表明，结肠周围肿瘤沉积是一种破坏性的静脉侵犯不同于其他类型的血管参与，这些病变可能会更好地被列入M类分期的目的。
The current TNM classification considers a tumor nodule in the pericolic/perirectal adipose tissue as venous invasion if the nodule has an irregular contour and as regional lymph node metastasis if the nodule has the form and smooth contour of a lymph node. However, detailed studies on the clinico-pathological implications of pericolonic tumor deposits and of extranodal extension are still lacking. We investigated the impact of these metastatic deposits in the pericolic fat in a series of 228 patients with advanced colon cancer. The pericolonic tumor deposits were characterized by their appearance, size, distance from the primary tumor and by their relation with the lymphatic tissue not organized in lymph nodes. These features were then compared with the clinico-pathological characteristics of the tumors and with the patients' survival. All these lesions were associated with reduced disease-free and overall survivals in a univariate analysis, but only pericolonic tumor deposits retained an independent prognostic role in the multivariate analysis. Our findings suggest that pericolonic tumor deposits are a destructive type of venous invasion different from other types of vessel involvement, and that these lesions may rather be included in the M category for staging purposes.