Reggiani Bonetti Luca, Di Gregorio Carmela, De Gaetani Carmela, Pezzi Annalisa, Barresi Gaetano, Barresi Valeria, Roncucci Luca, Ponz de Leon Maurizio
Dipartimento ad Attività Integrata di Laboratori, Anatomia Patologica e Medicina Legale, Sezione di Anatomia Patologica, Università di Modena e Reggio Emilia, Modena, Italy.
Scand J Gastroenterol. 2011 Jul;46(7-8):881-6. doi: 10.3109/00365521.2011.571708. Epub 2011 Apr 15.
Although patients with Stage I colorectal cancer show an excellent prognosis, a few of them die of metastatic disease. In this subgroup of individuals, the search of occult metastasis might reveal that early dissemination of tumor cells could be the cause of cancer progression.
Through a Cancer Registry, we selected all patients with Stage I disease who died of metastatic tumor; a total of 32 patients were identified and in 25 of them paraffin-embedded material was available. The group was matched to 70 Stage I patients with favorable prognosis (controls). In cases and controls resected lymph nodes were cut, and micrometastases were searched using pan-cytokeratin antibodies.
Micrometastases were detected in 18 of 25 (72%) Stage I patients who died of the disease, while they were almost absent among controls (1 of 70, p < 0.001 by χ(2) test). Vascular invasion and tumor budding were more frequent among Stage I patients with an unfavorable prognosis than in controls. By regression analyses, micrometastases (HR 12.3, CI 4.8-32) and vascular invasion (HR 3.5, CI 1.4-8.5) maintained an independent association with prognosis (cancer-specific survival).
Micrometastasis in the lymph nodes can be revealed in the majority of patients with early colorectal cancer who die of tumor progression, while they appear extremely rare in Stage I individuals with good prognosis. The selection of patients through histology (vascular invasion) and search of occult metastatic cells might represent a way to identify individuals who might benefit from adjuvant chemotherapy.
尽管I期结直肠癌患者预后良好，但仍有少数患者死于转移性疾病。在这一亚组患者中，寻找隐匿性转移可能会发现肿瘤细胞的早期播散可能是癌症进展的原因。
通过癌症登记处，我们选择了所有死于转移性肿瘤的I期疾病患者；共确定了32例患者，其中25例有石蜡包埋材料。该组与70例预后良好的I期患者（对照组）进行匹配。对病例组和对照组切除的淋巴结进行切片，使用泛细胞角蛋白抗体检测微转移。
在25例死于该疾病的I期患者中，有18例（72%）检测到微转移，而对照组中几乎未检测到（70例中有1例，χ(2)检验p<0.001）。预后不良的I期患者中血管侵犯和肿瘤芽生比对照组更常见。通过回归分析，微转移（风险比12.3，置信区间4.8 - 32）和血管侵犯（风险比3.5，置信区间1.4 - 8.5）与预后（癌症特异性生存）保持独立关联。
在大多数死于肿瘤进展的早期结直肠癌患者中可发现淋巴结微转移，而在预后良好的I期患者中极为罕见。通过组织学（血管侵犯）选择患者并寻找隐匿性转移细胞可能是识别可能从辅助化疗中获益的个体的一种方法。
