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肿瘤芽生的实际数量作为T1期结直肠癌个体化治疗的新工具。

Actual number of tumor budding as a new tool for the individualization of treatment of T1 colorectal carcinomas.

作者信息

Masaki Tadahiko, Matsuoka Hiroyoshi, Sugiyama Masanori, Abe Nobutsugu, Sakamoto Atsuhiko, Atomi Yutaka

机构信息

Department of Surgery, Kyorin University, Shinkawa, Mitaka City, Tokyo, Japan.

出版信息

J Gastroenterol Hepatol. 2006 Jul;21(7):1115-21. doi: 10.1111/j.1440-1746.2006.04073.x.

Abstract

BACKGROUND AND AIM

Treatment of T1 colorectal carcinomas, either local excision including endoscopic polypectomy or radical surgery, has always been problematic in everyday practice. Although previous studies have revealed that tumor budding at the invasive margin can be a marker for the malignant potential of T1 colorectal carcinomas, the evaluation of tumor budding has not been standardized as yet. In the present study, we attempted to apply the actual number of tumor budding units for the individualization of treatment in T1 colorectal carcinomas.

METHODS

In 76 T1 colorectal carcinomas, associations between lymph node metastasis and clinicopathological parameters were examined statistically. A mathematical formula for predicting the risk of lymph node metastasis was constructed and decision analysis was attempted to determine individually the indication for additional surgery after endoscopic mucosal resection of T1 colorectal carcinomas.

RESULTS

Of the clinicopathological parameters examined, multivariate analysis showed that the actual number of tumor budding units alone was significantly associated with lymph node metastasis. The probability of lymph node metastasis was calculated as Z = 0.07 x (budding counts) - 3.726, probability = 1/1 + e(-Z). The more the budding counts, the higher the probability of lymph node metastasis. This formula was able to accurately predict lymph node metastasis in successive cases. The actual number of tumor budding units can be applied to decision analysis in determining an indication for additional surgery after endoscopic mucosal resection of T1 colorectal carcinomas.

CONCLUSIONS

The actual number of tumor budding units may be useful in the decision making for patient-oriented treatment of T1 colorectal carcinomas.

摘要

背景与目的

在日常临床实践中,T1期结直肠癌的治疗,无论是局部切除(包括内镜下息肉切除术)还是根治性手术,一直都存在问题。尽管先前的研究表明,浸润边缘的肿瘤芽生可作为T1期结直肠癌恶性潜能的标志物,但肿瘤芽生的评估尚未标准化。在本研究中,我们试图应用肿瘤芽生单位的实际数量来实现T1期结直肠癌治疗的个体化。

方法

对76例T1期结直肠癌患者,统计分析淋巴结转移与临床病理参数之间的相关性。构建预测淋巴结转移风险的数学公式,并尝试通过决策分析来个体化确定T1期结直肠癌内镜黏膜切除术后追加手术的指征。

结果

在所检测的临床病理参数中,多因素分析显示仅肿瘤芽生单位的实际数量与淋巴结转移显著相关。淋巴结转移概率计算为Z = 0.07×(芽生计数) - 3.726,概率 = 1/1 + e(-Z)。芽生计数越多,淋巴结转移概率越高。该公式能够准确预测连续病例中的淋巴结转移情况。肿瘤芽生单位的实际数量可应用于决策分析,以确定T1期结直肠癌内镜黏膜切除术后追加手术的指征。

结论

肿瘤芽生单位的实际数量可能有助于T1期结直肠癌以患者为导向的治疗决策。

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