结直肠癌静脉侵犯分级的客观标准。

Objective criteria for the grading of venous invasion in colorectal cancer.

机构信息

Department of Surgery, National Defense Medical College, Tokorozawa, Japan.

出版信息

Am J Surg Pathol. 2010 Apr;34(4):454-62. doi: 10.1097/PAS.0b013e3181d296ef.

DOI:10.1097/PAS.0b013e3181d296ef

PMID:20216202

Abstract

PURPOSE

To establish an objective histologic grading system of venous invasion.

METHODS

A total of 229 patients with pT3 and pT4 colorectal cancer who underwent curative surgery with lymph node dissection were retrospectively analyzed. Potential prognosis-related characteristics of venous invasion, including the number of venous invasion, morphologic type of venous invasion, maximum size of veins invaded, and location of venous vessel involved were evaluated on elastica van Gieson stained sections.

RESULTS

The relapse-free survival curves between the venous-invasion-positive group and the negative group were significantly different (5 y survival rates were 73.4% and 92.2%, respectively, P=0.001). When patients were divided into 3 groups according to the average number of venous invasions observed in a glass slide [G0 (none), G1 (positive but <4), and G2 (4 or more)], there was a significant difference in the survival rate among the 3 groups [5 y survival rates were 92.2%, 77.8%, and 56.4%, respectively, P=0.008 (G0 vs. G1), P=0.017 (G1 vs. G2)]. The postoperative recurrence rate was 10.8% in the G0 patients, whereas it was 32.5% in the G1 and 51.7% in the G2 patients [P=0.0007 (G0 vs. G1), P=0.047 (G1 vs. G2)]. Multivariate analysis showed the number of venous invasions [hazard ratio (HR) 2.72, P=0.027], depth of invasion (HR 2.26, P=0.014), and lymph node metastasis (HR 2.43, P=0.008) were independent prognostic factors.

CONCLUSIONS

Three ranked tumor grading system based on the number of venous invasion in a glass slide with elastica van Gieson staining could be an objective and important treatment index for colorectal cancer patients.

摘要

目的

建立一种静脉侵犯的客观组织学分级系统。

方法

回顾性分析了 229 例接受根治性手术和淋巴结清扫术的 pT3 和 pT4 结直肠癌患者。在弹力纤维 van Gieson 染色切片上评估了静脉侵犯的潜在预后相关特征，包括静脉侵犯的数量、静脉侵犯的形态类型、受侵犯静脉的最大直径和受侵犯静脉的位置。

结果

静脉侵犯阳性组和阴性组的无复发生存曲线差异有统计学意义（5 年生存率分别为 73.4%和 92.2%，P=0.001）。当根据玻璃片上观察到的静脉侵犯平均数量将患者分为 3 组[G0（无）、G1（阳性但 <4）和 G2（4 个或更多）]时，3 组间的生存率差异有统计学意义[5 年生存率分别为 92.2%、77.8%和 56.4%，P=0.008（G0 与 G1），P=0.017（G1 与 G2）]。G0 患者的术后复发率为 10.8%，而 G1 和 G2 患者的复发率分别为 32.5%和 51.7%[P=0.0007（G0 与 G1），P=0.047（G1 与 G2）]。多因素分析显示静脉侵犯数量[风险比（HR）2.72，P=0.027]、浸润深度（HR 2.26，P=0.014）和淋巴结转移（HR 2.43，P=0.008）是独立的预后因素。