肿瘤芽生强度作为预测直肠浸润性癌恶性潜能的指标。
Intensity of tumor budding as an index for the malignant potential in invasive rectal carcinoma.
机构信息
Department of Surgery, Dong-A University College of Medicine, Busan, South Korea.
出版信息
Cancer Res Treat. 2005 Jun;37(3):177-82. doi: 10.4143/crt.2005.37.3.177. Epub 2005 Jun 30.
PURPOSE
The aim of this study was to quantitatively assess the intensity of tumor budding in rectal carcinoma and to determine how it correlates with the malignant potential.
MATERIALS AND METHODS
Intensities of the tumor budding at the invasive front of the surgical specimens from 90 patients (male, 51) with well- or moderately-differentiated rectal carcinoma were investigated. Differences in the budding intensity among pathologic variables were compared, and recurrences and survivals were analyzed in accordance with degree of the budding intensity. The patients ranged in age from 33 to 75 years (mean, 55.4) with the median follow-up being 43 months (range, 12 approximately 108).
RESULTS
Tumor budding was identified in 89 patients (98.9%) with a mean intensity of 7.5+/-5.3. The budding intensity was significantly higher in tumors with lymphatic invasion (p=0.0081), blood vessel invasion (p<0.0001), and perineural invasion (p=0.0013) than in those tumor without these findings. It became significantly higher with the increase in nodal stage (p<0.0001). The intensity of tumor budding in patients with relapse (29 patients) was significantly higher than that in patients without relapse (6.2+/-5.0 vs. 10.2+/-4.9; p=0.0005), but this difference in the intensity was observed only for the node-positive patients (8.0+/-3.4 vs. 11.9+/-5.1; p=0.0064). When the patients were stratified into two groups on either side of the mean of the intensity, the higher intensity group showed a significantly less favorable disease-free (DFS) and overall survival (OS) (p=0.0026 and 0.0205, respectively). Based on the multivariate analysis, the nodal stage and the intensity of budding proved to be the independent variables associated with DFS (p=0.023 and 0.03, respectively).
CONCLUSION
Tumor budding at the invasive margin is a reliable pathologic index that indicates a higher malignant potential and a less favorable prognosis for patients with advanced rectal carcinoma.
目的
本研究旨在定量评估直肠癌肿瘤芽的强度，并确定其与恶性潜能的相关性。
材料和方法
研究了 90 例（男性 51 例）分化良好或中等分化直肠癌手术标本的肿瘤芽在侵袭前沿的强度。比较了芽强度在不同病理变量之间的差异，并根据芽强度的程度分析了复发和生存情况。患者年龄 33 至 75 岁（平均 55.4 岁），中位随访时间为 43 个月（范围 12 至 108 个月）。
结果
89 例（98.9%）患者的肿瘤芽被识别，平均强度为 7.5+/-5.3。有淋巴管侵犯（p=0.0081）、血管侵犯（p<0.0001）和神经周围侵犯（p=0.0013）的肿瘤芽强度明显高于无这些发现的肿瘤。随着淋巴结分期的增加，芽强度明显增加（p<0.0001）。复发患者（29 例）的肿瘤芽强度明显高于无复发患者（6.2+/-5.0 比 10.2+/-4.9；p=0.0005），但这种强度差异仅见于淋巴结阳性患者（8.0+/-3.4 比 11.9+/-5.1；p=0.0064）。当将患者分为强度平均值两侧的两组时，较高强度组的无病生存期（DFS）和总生存期（OS）明显较差（p=0.0026 和 0.0205）。基于多变量分析，淋巴结分期和芽强度被证明是与 DFS 相关的独立变量（p=0.023 和 0.03）。
结论
肿瘤芽在侵袭边缘是一个可靠的病理指标，表明晚期直肠癌患者具有更高的恶性潜能和更差的预后。
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