Linares Santiago E, Sánchez Calzado J A, Capitán Morales L, Gómez Parra M, González Mariscal M J, Mendoza Olivares F J, Sáenz Dana M, Herrerías Gutiérrez J M
Digestive Department, Virgen Macarena University Hospital, Sevilla, Spain.
Rev Esp Enferm Dig. 2002 Feb;94(2):78-87.
To demonstrate the relationship between degree of cellular differentiation in colorectal cancer and topographical distribution in 215 patients diagnosed with colorectal cancer from 1997 to 2000.
215 patients (129 men and 86 women) were studied prospectively with a mean age of 64 years (range: 23-84 years). In all patients we performed a full colonoscopy with several biopsies (in patients with colon stenosis we used barium enema), radiographic studies (CT, abdominal ultrasounds), and laboratory tests for serum tumour markers (CEA, Ca 19-9, alpha-fetoprotein). The topographic location of colorectal cancer was: rectum 35%, sigmoid colon 31%, descending colon 10%, transverse colon 6%, ascending colon 9%, caecum 5%, and we included anorectal cancer 4%.
According to histological differentiation we found: A) well-differentiated tumours 101/215 (47%); B) moderately-differentiated tumours 98/215 (45.5%), and C) poorly-differentiated tumours 16/215 (7.5%). We found no significant association among histological differentiation, topographic location, stage according to the Astler-Coller classification, sex or age (p = ns). The prevalence of well-differentiated tumours in men was 49% and 43% in women; of moderately-differentiated cancers in men was 43%, and 49% in women; for poorly-differentiated tumours in men was 7.5%, and 7.2% in women. Regarding tumour location, 165 cancers were found in the left colon: 80 were well differentiated, 77 moderately differentiated and 8 poorly differentiated. In the transverse colon we found 12 tumours: 7 well differentiated, 3 moderately differentiated and 2 poorly differentiated. 30 cancers were localized in the right colon: 11 well differentiated, 15 moderately differentiated and 4 poorly differentiated. In the anorectum 8 tumours were found: 3 well differentiated, 3 moderately differentiated and 2 poorly differentiated. According to staging classification, well differentiated tumours (101/215) were more common in Dukes' C2 (20.7%) and B1 (32.6%), moderately differentiated cancers (98/215) were in B1 (28.5%) and C2 (20.4%), and poorly differentiated tumours (16) were more common in Dukes' C2 (25%), without differences among other stages (p = ns).
According to our results we have found that histological differentiation of colorectal cancer has no association with topographic location, and it is independent of sex or age. We have not found any relationship either between histological differentiation and stage in the Astler-Coller classification, but well differentiated cancers were more common at any location, age or sex.
探讨1997年至2000年确诊的215例结直肠癌患者的细胞分化程度与肿瘤部位分布之间的关系。
对215例患者（129例男性，86例女性）进行前瞻性研究，平均年龄64岁（范围：23 - 84岁）。所有患者均接受全结肠镜检查并多次活检（结肠狭窄患者采用钡灌肠）、影像学检查（CT、腹部超声）以及血清肿瘤标志物（癌胚抗原、糖类抗原19 - 9、甲胎蛋白）实验室检测。结直肠癌的部位分布为：直肠35%，乙状结肠31%，降结肠10%，横结肠6%，升结肠9%，盲肠5%，肛管直肠癌4%。
根据组织学分化程度，我们发现：A）高分化肿瘤101/215（47%）；B）中分化肿瘤98/215（45.5%）；C）低分化肿瘤16/215（7.5%）。我们发现组织学分化程度、肿瘤部位、Astler - Coller分期、性别或年龄之间均无显著关联（p = 无显著性差异）。男性高分化肿瘤的患病率为49%，女性为43%；男性中分化癌的患病率为43%，女性为49%；男性低分化肿瘤的患病率为7.5%，女性为7.2%。关于肿瘤位置，左半结肠发现165例癌症：80例高分化，77例中分化，8例低分化。在横结肠我们发现12例肿瘤：7例高分化，3例中分化，2例低分化。右半结肠有30例癌症：11例高分化，15例中分化，4例低分化。在肛管直肠发现8例肿瘤：3例高分化，3例中分化，2例低分化。根据分期分类，高分化肿瘤（101/215）在Dukes' C2期（20.7%）和B1期（32.6%）更为常见，中分化癌（98/215）在B1期（28.5%）和C2期（20.4%），低分化肿瘤（16例）在Dukes' C2期（25%）更为常见，其他分期之间无差异（p = 无显著性差异）。
根据我们的研究结果，我们发现结直肠癌的组织学分化与肿瘤部位无关，且与性别或年龄无关。我们也未发现组织学分化与Astler - Coller分期之间存在任何关系，但高分化癌在任何部位、年龄或性别中更为常见。
