Institute of Pathology, Medical University, Auenbruggerplatz 25, Graz, Austria.
Hum Pathol. 2010 Dec;41(12):1749-57. doi: 10.1016/j.humpath.2010.04.018.
The prognostic significance of tumor necrosis in colorectal cancer is unclear. Our study aimed to analyze the prognostic value of tumor necrosis with respect to progression-free and cancer-specific survival and to relate findings to expression of proteins involved in the control of cancer cell death, such as p53 and bcl-2. A total of 381 colorectal cancer specimens were retrospectively reevaluated. The extent of tumor necrosis was semiquantitatively assessed and recorded as either absent, focal (≤10% of the tumor area), moderate (10%-30%), or extensive (≥30%). Expression of p53 and bcl-2 was assessed immunohistochemically and recorded as either positive (using a cutoff value of 10%) or negative. In addition, mismatch repair protein status was assessed by immunohistochemistry using antibodies directed against hMLH1, hMSH2, and hMSH6. Tumor necrosis was observed in 365 (96%) cases, with 180 (47%) tumors showing focal necrosis, 119 (31%) moderate necrosis, and 66 (17%) extensive necrosis, respectively. Extent of necrosis was significantly associated with high T classification (P < .001), high N classification (P = .005), high International Union Against Cancer stage (P < .001), poor tumor differentiation (P < .001), large tumor size (P < .001), and blood vessel invasion (P = .01). No association of tumor necrosis with expression of p53, bcl-2, and mismatch repair protein status was observed. Tumor necrosis proved to be an independent prognostic variable with respect to progression-free and cancer-specific survival. In conclusion, tumor necrosis showed significant impact on prognosis of colorectal cancer patients. Its presence is readily assessable in hematoxylin and eosin-stained sections and should therefore routinely be commented upon in the pathology report.
结直肠癌中肿瘤坏死的预后意义尚不清楚。本研究旨在分析肿瘤坏死与无进展生存和癌症特异性生存的相关性，并将研究结果与涉及控制癌细胞死亡的蛋白表达相关联，如 p53 和 bcl-2。回顾性重新评估了 381 例结直肠癌标本。肿瘤坏死程度采用半定量评估，并记录为无、局灶性（≤肿瘤面积的 10%）、中度（10%-30%）或广泛（≥30%）。采用免疫组织化学方法评估 p53 和 bcl-2 的表达，并记录为阳性（使用 10%的截断值）或阴性。此外，采用针对 hMLH1、hMSH2 和 hMSH6 的抗体的免疫组织化学方法评估错配修复蛋白状态。365 例（96%）病例中观察到肿瘤坏死，其中 180 例（47%）肿瘤表现为局灶性坏死，119 例（31%）为中度坏死，66 例（17%）为广泛坏死。坏死程度与高 T 分类（P<0.001）、高 N 分类（P=0.005）、高国际抗癌联盟分期（P<0.001）、肿瘤分化差（P<0.001）、肿瘤较大（P<0.001）和血管侵犯（P=0.01）显著相关。肿瘤坏死与 p53、bcl-2 和错配修复蛋白状态的表达无相关性。肿瘤坏死是无进展生存和癌症特异性生存的独立预后因素。总之，肿瘤坏死对结直肠癌患者的预后有显著影响。它在苏木精和伊红染色切片中易于评估，因此在病理报告中应常规进行描述。
