Apoptosis as a prognostic factor in colorectal carcinoma.

我们用原位末端标记法(byterminal-deoxynucleotidyl-transferase-mediated-dUTP-bitin nick end mark，TUNEL)检测了104例结直肠癌组织中细胞凋亡的发生情况，以探讨细胞凋亡是否可作为判断预后的指标。凋亡指数(AI)计算为每1000个癌细胞中阳性癌细胞的百分比。AI中位数为4.1(1.9~4.7)。在恶性潜能较高的肿瘤中，如晚期(Dukes B、C和D期)，细胞凋亡的发生率低于Dukes A期(p&lt；0.05)，而在中度分化的肿瘤中，细胞凋亡的发生率低于高分化的肿瘤(p&lt；0.05)。在有静脉侵犯或淋巴结转移的肿瘤中，其发生率也低于没有这些特征的肿瘤(p&lt；0.05)。此外，Dukes C期肿瘤中AI高的亚组(5年生存率分别为33%和68%，p&lt；0.05；Cox-Mantel)。我们的研究结果提示，细胞凋亡越少，结直肠癌进展越快，细胞凋亡率可能是判断结直肠癌恶性程度的指标之一。此外，肿瘤细胞的凋亡率可能是判断结直肠癌预后的有用因素。

We investigated the occurrence of apoptotic cell death in 104 colorectal carcinomas byterminal-deoxynucleotidyl-transferase-mediated dUTP-biotin nick end labeling (TUNEL) in order to examine whether or not apoptosis might be useful as a prognostic factor. An apoptotic index (AI) was caluculated as the percentage of positine cancer cells per 1,000 cancer cells. The median value of AI was 4.1 (range, 1.9-4.7). Apoptosis was less frequently-observed in tumors with higher malignannt potential, such as tumors at advanced stages (Dukes B,C and D), than at Dukes A (p<0.05), and it was less frequent in tumors with evidence of moderate differentiation than in those with evidence of well differentiation (p<0.05). It was also less frequent in tumors with venous invasion or lymph node metastasis than in those without these features (p<0.05). Moreover, the subgroup with a high AI in tumors at Dukes stage C (five-year survival rates were 33% vs. 68%, p<0.05 ; Cox-Mantel). Our findings suggest that less apoptosis might result in greater progression of colorectal carcinomas and the rate of apoptosis might be one of the indicators of the degree of malignancy. Moreover, it appears that the frequency of apoptosis in tumor cells might be useful prognostic factor in colorectal carcinoma.