Torres C M, Wang H H, Turner J R, Richards W, Sugarbaker D, Shahsafaei A, Odze R D
Department of Pathology, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts 02115, USA.
Mod Pathol. 1999 Oct;12(10):961-8.
One of the primary goals of pathologic examination of esophageal squamous cell carcinoma resection specimens is to provide information regarding morphologic features which can help prognosticate and guide management of affected patients. The purpose of this study was to determine the prognostic utility of a variety of histopathologic prognostic factors in patients with esophageal squamous cell carcinoma with and without preoperative chemotherapy and radiotherapy (chemrad). Multiple clinical and histologic features such as peri-tumoral lymphocytic infiltrate, Crohn's-like lymphoid reaction, degree of residual tumor, mitosis per 1000 cells, tumor differentiation, lymphatic/vascular invasion, perineural invasion, desmoplastic reaction, and tumor growth pattern were evaluated in patients with (53) and without (21) preoperative chemrad and correlated with survival (mean follow-up, 25 mo). Data were analyzed for the entire cohort and for each separate treatment group by univariate and multivariate analysis. Patients who received chemrad showed no significant survival benefit (hazard ratio = 2.5, P = .10). In the whole cohort of patients, higher pathologic stage (P = .04), poor tumor differentiation (P = .003), increased mitotic count (P = .005), perineural invasion (P = .01), lymphatic/vascular invasion (P = .002), tumor size (P = .05), and absence of a Crohn's-like lymphoid reaction (P = .05) were significantly associated with poor survival by univariate analysis. In multivariate analysis, poor tumor differentiation (P = .005), high mitotic count (P = .01), and vascular invasion (P = .03) were important prognostic features, independent of pathologic stage, for the entire cohort. In the chemrad group only, tumor size (in patients with macroscopic residual tumor) (P = .05), lymph node metastasis (P = .03), mitotic count (P = .01), and lymphatic/vascular invasion (P = .02) were significant prognostic indicators by univariate analysis. Upon multivariate analysis, only lymphatic/vascular invasion (P = .02) and mitotic rate (P = .01) were independent predictors of survival. In the nonchemrad group, only tumor differentiation was significant by both univariate (P = .008) and multivariate analysis (P = .03). The differences in pathologic prognostic factors between chemrad and nonchemrad treated cases suggests that chemrad has a significant effect on the biologic properties of these tumors.
食管鳞状细胞癌切除标本病理检查的主要目标之一是提供有关形态学特征的信息，这些信息有助于预测和指导受影响患者的治疗。本研究的目的是确定各种组织病理学预后因素在接受和未接受术前化疗和放疗（放化疗）的食管鳞状细胞癌患者中的预后价值。对53例接受术前放化疗和21例未接受术前放化疗患者的多种临床和组织学特征进行了评估，如肿瘤周围淋巴细胞浸润、克罗恩样淋巴反应、残留肿瘤程度、每1000个细胞的有丝分裂数、肿瘤分化、淋巴管/血管侵犯、神经周围侵犯、促纤维增生性反应和肿瘤生长模式，并与生存率（平均随访25个月）进行关联分析。通过单因素和多因素分析对整个队列以及每个单独治疗组的数据进行分析。接受放化疗的患者未显示出显著的生存获益（风险比=2.5，P=0.10）。在整个患者队列中，单因素分析显示，较高的病理分期（P=0.04）、较差的肿瘤分化（P=0.003）、有丝分裂计数增加（P=0.005）、神经周围侵犯（P=0.01）、淋巴管/血管侵犯（P=0.002）、肿瘤大小（P=0.05）以及无克罗恩样淋巴反应（P=0.05）与较差的生存率显著相关。多因素分析显示，较差的肿瘤分化（P=0.005）、高有丝分裂计数（P=0.01）和血管侵犯（P=0.03）是整个队列中独立于病理分期的重要预后特征。仅在放化疗组中，单因素分析显示肿瘤大小（在有肉眼残留肿瘤的患者中）（P=0.05）、淋巴结转移（P=0.03）、有丝分裂计数（P=0.01）和淋巴管/血管侵犯（P=0.02）是显著的预后指标。多因素分析显示，只有淋巴管/血管侵犯（P=0.02）和有丝分裂率（P=0.01）是生存的独立预测因素。在未接受放化疗组中，单因素（P=0.008）和多因素分析（P=0.03）均显示只有肿瘤分化具有显著性。放化疗和未放化疗治疗病例之间病理预后因素的差异表明放化疗对这些肿瘤的生物学特性有显著影响。
