Ogawa Masaichi, Watanabe Michiaki, Eto Ken, Kosuge Makoto, Yamagata Tetsuya, Kobayashi Tetsuya, Yamazaki Kazuya, Anazawa Sadao, Yanaga Katsuhiko
Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan.
Hepatogastroenterology. 2008 May-Jun;55(84):907-11.
BACKGROUND/AIMS: The aims of this study were to assess the prognosis and histopathological factors of poorly differentiated colorectal adenocarcinoma, and the clinical relevance of the proposed histopathological sub classifications.
Fifty eight patients with poorly differentiated adenocarcinoma were enrolled in this study. According to the lymphatic canal spread in tumor tissue, they were classified into lymphangitic type (tumor spread beyond the intra mucosal tumor space through the lymphatic canal widely) and non-lymphangitic type (tumor spread within that space). Next, they were sub classified into medullary, intermediate and scirrhous types according to the amount of fibrous stroma. In addition, immunohistological examinations were performed on the expression of an intercellular adhesion molecule (E-cadherin).
In 33 cases (57%) Lymphangitic type was present and in 25 cases non-lymphangitic type (43%) was present. In the lymphangitic types, 5 cases were medullary type (15%), 17 cases were intermediate type (52%) and 11 cases were scirrhous type (33%) that included 2 cases of signet ring cell carcinoma. In the non-lymphangitic types, medullary type was dominant (20 cases, 80%) while intermediate type and scirrhous type were 3 cases (12%) and 2 cases (8%), respectively. The survival rates were calculated for both types and a large difference was found in terms of 5-year survival rate; 0% for lymphangitic type and 72% for non-lymphangitic type (p<0.05). There was no correlation found between the expression of cadherin and the subclassification.
In conclusion, a wide tumor infiltration and growth in lymphatic vessels appears to be an important prognostic factor for poorly differentiated adenocarcinoma compared to the metastasis patterns.
背景/目的：本研究旨在评估低分化结直肠癌的预后和组织病理学因素，以及所提出的组织病理学亚分类的临床相关性。
本研究纳入了58例低分化腺癌患者。根据肿瘤组织中的淋巴管扩散情况，将他们分为淋巴管型（肿瘤通过淋巴管广泛扩散至黏膜内肿瘤间隙之外）和非淋巴管型（肿瘤在该间隙内扩散）。接下来，根据纤维基质的数量将他们进一步分为髓样、中间型和硬癌型。此外，对细胞间粘附分子（E-钙粘蛋白）的表达进行了免疫组织学检查。
33例（57%）为淋巴管型，25例（43%）为非淋巴管型。在淋巴管型中，5例为髓样型（15%），17例为中间型（52%），11例为硬癌型（33%），其中包括2例印戒细胞癌。在非淋巴管型中，髓样型占主导（20例，80%），而中间型和硬癌型分别为3例（12%）和2例（8%）。计算了两种类型的生存率，发现5年生存率有很大差异；淋巴管型为0%，非淋巴管型为72%（p<0.05）。未发现钙粘蛋白表达与亚分类之间存在相关性。
总之，与转移模式相比，肿瘤在淋巴管中的广泛浸润和生长似乎是低分化腺癌的一个重要预后因素。
