Di Gregorio Carmela, Bonetti Luca Reggiani, de Gaetani Carmela, Pedroni Monica, Kaleci Shaniko, Ponz de Leon Maurizio
Dipartimento ad attività integrata di Laboratori, Anatomia Patologica e Medicina Legale, Sezione di Anatomia Patologica, Policlinico, Via del Pozzo 71, 41100, Modena, Italy,
Intern Emerg Med. 2014 Mar;9(2):151-60. doi: 10.1007/s11739-012-0772-2. Epub 2012 Mar 27.
Some histological features of malignant polyps have been used to classify patients into low- and high-risk groups. This study proposed to evaluate the impact of this classification on the clinical outcome of patients with malignant polyps. Through the Colorectal Cancer Registry, 105 patients with endoscopically removed malignant polyps were selected. The presence of one of the following histological features defined malignant polyps as high-risk: infiltrated resection-margin, poorly differentiated carcinoma, lymphatic/vascular invasion and tumour budding and depth of submucosal invasion. Available literature was reviewed by applying a similar classification. Most of the malignant polyps were pedunculated and were localized in the left colon. Fifty-five malignant polyps were classified as low-risk lesions and 50 as high-risk. None of the patients at low-risk died of colorectal cancer. Of the patients at high-risk, three died of cancer; all three cases showed lymphatic/vascular invasion. Review of the literature reveals that an unfavourable clinical outcome is significantly more prevalent in the high-risk compared with the low-risk group (p > 0.005). Moreover, all histological risk factors show a specific predictive value of clinical adverse outcome. Our study and the pooled data analysis confirmed the usefulness of the subdivision into low- and high-risk malignant polyps for management of patients with endoscopically removed colorectal carcinoma.
恶性息肉的一些组织学特征已被用于将患者分为低风险和高风险组。本研究旨在评估这种分类对恶性息肉患者临床结局的影响。通过结直肠癌登记处，选取了105例经内镜切除恶性息肉的患者。以下组织学特征之一的存在将恶性息肉定义为高风险：切缘浸润、低分化癌、淋巴/血管侵犯、肿瘤芽生以及黏膜下浸润深度。通过应用类似的分类对现有文献进行了综述。大多数恶性息肉有蒂，且位于左半结肠。55例恶性息肉被分类为低风险病变，50例为高风险。低风险组患者均未死于结直肠癌。高风险组患者中有3例死于癌症；所有3例均显示有淋巴/血管侵犯。文献综述显示，与低风险组相比，高风险组不良临床结局的发生率显著更高（p>0.005）。此外，所有组织学风险因素均显示出对临床不良结局的特定预测价值。我们的研究和汇总数据分析证实了将恶性息肉细分为低风险和高风险对于经内镜切除结直肠癌患者管理的有用性。
