Institute of Pathology, Medical University, Auenbruggerplatz 25, 8036 Graz, Austria.
Int J Colorectal Dis. 2010 Feb;25(2):187-96. doi: 10.1007/s00384-009-0801-4. Epub 2009 Oct 9.
Tumour stage is the strongest prognostic parameter in colorectal cancer. The study aimed to evaluate the prognostic impact of pT2, pT3, and pT4 sub-classification.
Three hundred eighty-one surgical colorectal cancer specimens were retrospectively re-evaluated. pT2 tumours were sub-classified according to infiltration of the inner circumferential (pT2a) or outer longitudinal (pT2b) layer of the muscularis propria. pT3 tumours were sub-classified by measuring the maximal tumour invasion beyond the outer border of the muscularis propria (pT3a <or= 1 mm, pT3b > 1-5 mm, pT3c > 5-15 mm, and pT3d > 15 mm). pT4 tumours were sub-classified according to invasion of other organs or structures (pT4a) or perforation of the visceral peritoneum (pT4b). Data were correlated with other pathological parameters and patient outcome.
Seventy pT2 tumours were re-classified as 37 pT2a and 33 pT2b tumours. There was no significant association with tumour grade, angioinvasion, or lymph node involvement and no significant impact on prognosis. Two hundred eighteen pT3 tumours were re-classified as 49 pT3a, 83 pT3b, 53 pT3c, and 33 pT3d tumours. pT3 sub-classification was significantly associated with tumour grade, angioinvasion, and lymph node involvement and proved to be an independent prognostic variable with respect to progression-free and cancer-specific survival. A cut-off level of 5 mm is recommended. Sixty-five pT4 tumours were re-classified as 15 pT4a and 50 pT4b tumours. There was no significant association with tumour grade, angioinvasion, or lymph node involvement and no significant impact on prognosis.
pT3 sub-classification was significantly associated with patient outcome. In contrast, pT2 and pT4 sub-classification did not show clinical significance.
肿瘤分期是结直肠癌最强的预后参数。本研究旨在评估 pT2、pT3 和 pT4 亚分类的预后影响。
回顾性评估 381 例结直肠手术标本。pT2 肿瘤根据固有肌层内环层（pT2a）或外纵层（pT2b）的浸润进行亚分类。pT3 肿瘤通过测量固有肌层外边界以外的最大肿瘤浸润程度进行亚分类（pT3a≤1mm、pT3b>1-5mm、pT3c>5-15mm 和 pT3d>15mm）。pT4 肿瘤根据侵犯其他器官或结构（pT4a）或穿透内脏腹膜（pT4b）进行亚分类。将数据与其他病理参数和患者预后相关联。
70 例 pT2 肿瘤重新分类为 37 例 pT2a 和 33 例 pT2b 肿瘤。与肿瘤分级、血管侵犯或淋巴结受累无显著相关性，对预后无显著影响。218 例 pT3 肿瘤重新分类为 49 例 pT3a、83 例 pT3b、53 例 pT3c 和 33 例 pT3d 肿瘤。pT3 亚分类与肿瘤分级、血管侵犯和淋巴结受累显著相关，是无进展生存期和癌症特异性生存期的独立预后变量。建议截断值为 5mm。65 例 pT4 肿瘤重新分类为 15 例 pT4a 和 50 例 pT4b 肿瘤。与肿瘤分级、血管侵犯或淋巴结受累无显著相关性，对预后无显著影响。
pT3 亚分类与患者预后显著相关。相比之下，pT2 和 pT4 亚分类没有显示出临床意义。
