Mitomi Hiroyuki, Mori Akio, Kanazawa Hideki, Nishiyama Yasuhiko, Ihara Atsushi, Otani Yoshimasa, Sada Miwa, Kobayashi Kiyonori, Igarashi Masahiro
Department of Clinical Research Laboratory, Pathology Division, National Hospital Organization Sagamihara Hospital, Kanagawa, Japan.
Hepatogastroenterology. 2005 Sep-Oct;52(65):1421-6.
BACKGROUND/AIMS: Liver and lymph node metastasis the major prognostic factor in patients with colorectal carcinoma. The aim of this work was to search for tumor parameters which can be employed to predict whether this has occurred.
A total of 211 patients with a colorectal carcinoma (Dukes' B group, 83; Dukes' C, 94; Dukes' D, 34) were investigated for 10 clinicopathological variables, as well as apoptotic activity, expression of Ki-67, p21(WAF1/CIP1), p53, bcl-2 and DCC proteins, and the c-Ki-ras mutations. Data were analyzed by univariate and multivariate statistics.
Lymph node metastasis-predictive models were developed using the venous involvement index (the number of vascular involvements per elastica van Gieson-stained slide; Odds ratio [OR], 2.38; 95% confidence interval [CI], 1.52-3.71; p=0.0001), tumor size (OR, 0.82; 95% CI, 0.70-0.97; p=0.0179), and p21(WAF1/CIP1) immunolabeled index (the percentages of positive tumor cells; OR, 0.76; 95% CI, 0.64-0.90; p=0.0011). Liver metastasis-predictive models were developed using the venous involvement index (OR, 2.40; 95% CI, 1.71-3.37; p=0.0000) and tumor location (rectum vs. colon; OR, 9.31; 95% CI, 2.41-36.01; p=0.0012).
Down-regulation of p21(WAF1/CIP1) as well as marked venous involvement, small tumor size and colonic tumor are associated with lymph node and/or liver metastasis. Criteria for assessment of metastasis risk provide a basis for additional treatment guidelines.
背景/目的：肝转移和淋巴结转移是结直肠癌患者主要的预后因素。本研究旨在寻找可用于预测是否发生转移的肿瘤参数。
共对211例结直肠癌患者（Dukes' B组83例、Dukes' C组94例、Dukes' D组34例）进行了10项临床病理变量、凋亡活性、Ki-67、p21（WAF1/CIP1）、p53、bcl-2和DCC蛋白表达以及c-Ki-ras突变情况的研究。采用单因素和多因素统计学方法对数据进行分析。
利用静脉侵犯指数（每张小弹力纤维染色切片上血管侵犯的数量；优势比[OR]，2.38；95%置信区间[CI]，1.52 - 3.71；p = 0.0001）、肿瘤大小（OR，0.82；95% CI，0.70 - 0.97；p = 0.0179）和p21（WAF1/CIP1）免疫标记指数（阳性肿瘤细胞百分比；OR，0.76；95% CI，0.64 - 0.90；p = 0.0011）建立了淋巴结转移预测模型。利用静脉侵犯指数（OR，2.40；95% CI，1.71 - 3.37；p = 0.0000）和肿瘤位置（直肠与结肠；OR，9.31；95% CI，2.41 - 36.01；p = 0.0012）建立了肝转移预测模型。
p21（WAF1/CIP1）下调以及明显的静脉侵犯、较小的肿瘤大小和结肠肿瘤与淋巴结和/或肝转移相关。转移风险评估标准为额外的治疗指南提供了依据。
