Tumour necrosis is a postoperative prognostic marker for pancreatic cancer patients with a high interobserver reproducibility in histological evaluation.
Tumour necrosis is a postoperative prognostic marker for pancreatic cancer patients with a high interobserver reproducibility in histological evaluation.
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DOI：
10.1038/sj.bjc.6605854
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发表时间：
2010-09-28
影响因子：
8.8
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中科院分区：
文献类型：
--
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肿瘤坏死反映了缺氧的存在，这可能预示着肿瘤具有侵袭性表型。本研究的目的是探讨组织学坏死是否可作为胰腺导管癌（PDC）患者预后的有用预测指标。
我们回顾了348例PDC的组织病理学结果，并与临床病理信息进行了比较。除了以往研究中仅定义为坏死的大片坏死外，我们还将小坏死灶（微坏死）计为坏死。通过让五名独立的观察者对51例PDC进行盲法评估，测试了识别组织学参数的可重复性。
微坏死和大片坏死都与免疫组化检测到的表达碳酸酐酶IX的缺氧灶相对应。多变量生存分析显示，就PDC患者的无病生存期（DFS）和疾病特异性生存期（DSS）而言，组织学坏死是不良预后的独立预测因素。此外，转移状态以及淋巴管、静脉和胰腺内神经侵犯是DFS缩短的独立预后因素，而转移状态、切缘状态、淋巴管侵犯和胰腺内神经侵犯是DSS的独立预后因素。五名独立观察者之间坏死识别的观察者间一致性为“几乎完美”（κ值为0.87）。
组织学坏死是PDC患者术后预后的一种简单、准确且可重复的预测指标。
Tumour necrosis reflects the presence of hypoxia, which can be indicative of an aggressive tumour phenotype. The aim of this study was to investigate whether histological necrosis is a useful predictor of outcome in patients with pancreatic ductal carcinoma (PDC). We reviewed histopathological findings in 348 cases of PDC in comparison with clinicopathological information. We counted small necrotic foci (micronecrosis) as necrosis, in addition to massive necrosis that had been only defined as necrosis in previous studies. The reproducibility of identifying histological parameters was tested by asking five independent observers to blindly review 51 examples of PDC. Both micronecrosis and massive necrosis corresponded to hypoxic foci expressing carbonic anhydrase IX detected by immunohistochemistry. Multivariate survival analysis showed that histological necrosis was an independent predictor of poor outcome in terms of both disease-free survival (DFS) and disease-specific survival (DSS) of PDC patients. In addition, metastatic status, and lymphatic, venous, and intrapancreatic neural invasion were independent prognostic factors for shorter DFS and metastatic status, margin status, lymphatic invasion, and intrapancreatic neural invasion were independent prognostic factors for DSS. The interobserver reproducibility of necrosis identification among the five independent observers was ‘almost perfect’ (κ-value of 0.87). Histological necrosis is a simple, accurate, and reproducible predictor of postoperative outcome in PDC patients.
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