Histological categorisation of fibrotic cancer stroma in advanced rectal cancer
Histological categorisation of fibrotic cancer stroma in advanced rectal cancer
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DOI：
10.1136/gut.2003.028365
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发表时间：
2004-04-01
期刊：
影响因子：
24.5
通讯作者：
Talbot, IC
中科院分区：
文献类型：
--
作者：
Ueno, H;Jones, AM;Talbot, IC
背景和目的：根据关于纤维化间质反应在癌症发生中的作用的相互矛盾的报道--即促纤维增生反应可以有利于宿主或肿瘤--很明显，间质反应的作用是不同的。我们根据组织学鉴定的间质成分，对直肠腺癌穿透固有肌的纤维间质进行了分类。方法：使用三种类型的间质：成熟--当间质由成熟的胶原纤维(细长的纤维分成多层)组成时；中间--当瘢痕疙瘩样胶原与成熟纤维混合时；以及不成熟--由粘液样间质组成，其中不包括成熟纤维。结果：在862例患者中，53%的患者有成熟的纤维性癌间质，33%的患者有中间间质，15%的患者有不成熟的间质。5年生存率下降顺序为：成熟间质(80%)、中间间质(55%)和未成熟间质(27%)。在有不良纤维间质的肿瘤中，在肿瘤前沿观察到不利的肿瘤表型，即肿瘤细胞萌芽(明显的孤立细胞或小的癌细胞簇)(p<；0.0001)。基于多变量分析，将分类的纤维间质作为独立的预后参数(风险比1.39；95%可信区间1.17-1.64)与肿瘤分化一起被选为独立的预后参数。免疫组织化学检查显示，随着纤维化间质成熟度的降低，间质T细胞明显稀疏。结论：纤维性癌间质的形态分类突出了间质反应与直肠腺癌的行为和宿主免疫反应的关系，是预测患者预后的有用工具。
Background and aims: Based on conflicting reports regarding the role of the fibrotic stromal response in cancer development - namely, that a desmoplastic reaction can favour either the host or the tumour - it is clear that the role of the stromal response is varied. We have classified the fibrotic stroma of rectal adenocarcinoma penetrating the muscularis propria, based on histologically identified stromal components.Methods: Three categories of stroma were used: mature - when the stroma was composed of mature collagen fibres ( fine and elongated fibres into multiple layers); intermediate - when keloid-like collagen was intermingled with mature fibres; and immature - consisting of a myxoid stroma in which no mature fibres were included.Results: In a data set of 862 patients, 53% of patients had mature fibrotic cancer stroma, 33% had intermediate stroma, and 15% had immature stroma. Five year survival rates decreased as follows: mature stroma ( 80%), intermediate stroma (55%), and immature stroma (27%). The adverse tumour phenotype, tumour cell budding ( conspicuous isolated cells or small clusters of cancer cells), was observed in the cancer fronts in tumours with unfavourable fibrotic stroma (p< 0.0001). Based on multivariate analysis, categorised fibrotic stroma was selected as an independent prognostic parameter ( hazard ratio 1.39; 95% confidence interval 1.17 - 1.64) together with tumour differentiation. By immunohistochemical examination, as maturation of the fibrotic stroma decreased, stromal T cells became significantly sparser. Furthermore, myofibroblasts were distributed extensively in immature fibrotic stroma compared with mature and intermediate fibrotic stroma.Conclusion: The morphological categorisation of fibrotic cancer stroma highlights the role of the stromal response in relation to the behaviour and host immune reactions of rectal adenocarcinoma and would be a useful tool for predicting patient prognostic outcome.