Nielsen H J, Hansen U, Christensen I J, Reimert C M, Brünner N, Moesgaard F
Department of Surgical Gastroenterology, Hvidovre University Hospital, Hvidovre, Denmark.
J Pathol. 1999 Dec;189(4):487-95. doi: 10.1002/(SICI)1096-9896(199912)189:4<487::AID-PATH484>3.0.CO;2-I.
Overall peritumoural inflammatory cell infiltration is a prognostic variable in solid tumours, but the survival-related impact of the individual cell types within the infiltrate has still not been fully evaluated and compared with the conventional disease classification. In the present study, the prognostic value of individual white cell counts in the peritumoural inflammatory infiltrate in colorectal cancer was assessed. Intra-operative tumour tissue samples from 584 patients undergoing elective surgery for colorectal cancer were included. None of the patients received pre- or post-operative adjuvant chemotherapy. Tissue blocks were cut from the periphery of the tumours and embedded in paraffin. All blocks included both tumour tissue and normal bowel tissue. Serial sections of 4 microm were analysed for tumour tissue inflammatory cell infiltration using a computer- and video-assisted microscope, which allowed semi-automated quantification of cells within a fixed area. Total white cells and individual counts of eosinophils, neutrophils, mast cells, lymphocytes, and plasma cells were evaluated in every tumour specimen. Stratification into four groups with similar numbers of events was used to dichotomize the cell counts with respect to survival. The median observation period was 61 (49-75) months. In a multivariate analysis including Dukes' stage, gender, age, peri-operative blood transfusion, tumour location, and counts of specific inflammatory cells, only advanced Dukes' stage ( p< 0.0001), high age ( p=0.0003), and tumour location in the rectum predicted poor survival, while high counts of eosinophils ( p=0.006) and mast cells ( p=0.02) predicted good survival. Tumour-associated eosinophilia and mastocytosis appear to be independent prognostic variables in colorectal cancer. Future studies should investigate the potential biological role of tumour tissue eosinophils and mast cells in the modulation of tumour growth.
总体而言，肿瘤周围炎性细胞浸润是实体瘤的一个预后变量，但浸润内单个细胞类型对生存的影响尚未得到充分评估，也未与传统疾病分类进行比较。在本研究中，评估了结直肠癌肿瘤周围炎性浸润中单个白细胞计数的预后价值。纳入了584例接受择期结直肠癌手术的患者的术中肿瘤组织样本。所有患者均未接受术前或术后辅助化疗。从肿瘤周边切取组织块并石蜡包埋。所有组织块均包含肿瘤组织和正常肠组织。使用计算机和视频辅助显微镜对4微米的连续切片进行肿瘤组织炎性细胞浸润分析，该显微镜可对固定区域内的细胞进行半自动定量。对每个肿瘤标本评估总白细胞以及嗜酸性粒细胞、中性粒细胞、肥大细胞、淋巴细胞和浆细胞的个体计数。采用分层法将事件数相似的患者分为四组，以便根据生存情况对细胞计数进行二分法分析。中位观察期为61（49 - 75）个月。在一项多变量分析中，纳入了Dukes分期、性别、年龄、围手术期输血、肿瘤位置以及特定炎性细胞计数等因素，结果显示只有晚期Dukes分期（p < 0.0001）、高龄（p = 0.0003）和直肠肿瘤位置预示着较差的生存，而嗜酸性粒细胞（p = 0.006）和肥大细胞（p = 0.02）计数高则预示着较好的生存。肿瘤相关的嗜酸性粒细胞增多和肥大细胞增多似乎是结直肠癌独立的预后变量。未来的研究应调查肿瘤组织嗜酸性粒细胞和肥大细胞在调节肿瘤生长中的潜在生物学作用。
