结直肠癌肝转移的组织学生长模式具有预后价值。

The histological growth pattern of colorectal cancer liver metastases has prognostic value.

机构信息

Translational Cancer Research Unit, Augustinus Hospital, Oosterveldlaan 24, 2610, Wilrijk, Antwerp, Belgium.

出版信息

Clin Exp Metastasis. 2012 Aug;29(6):541-9. doi: 10.1007/s10585-012-9469-1. Epub 2012 Apr 3.

Abstract

Little is known about the biological characteristics that determine the prognosis of colorectal cancer (CRC) liver metastases. In previous work we reported three different histological patterns of the tumour-liver interface of CRC liver metastases, termed the pushing, replacement and desmoplastic growth pattern (GP). The purpose of this study was to confirm differences in angiogenic and hypoxic properties of CRC liver metastases with different GPs in a large data set and to study the value of the GP as a prognostic factor. In 205 patients undergoing a resection of CRC liver metastases, the GP of the metastasis was determined using haematoxylin-eosin and Gordon Sweet's silver staining. The tumour cell proliferation fraction (TCP%), endothelial cell proliferation fraction (ECP%) and carbonic anhydrase 9 (CA9) expression were determined using immunohistochemistry. Standard clinicopathological data and overall survival were recorded. 27.8, 15.6, 34.6 and 17.6 % of liver metastases had a replacement, pushing, desmoplastic and mixed GP, respectively. Analyses of TCP%, ECP% and CA9 expression demonstrated that CRC liver metastases with a replacement GP are non-angiogenic, while the ones with a pushing GP are the most angiogenic with angiogenesis being, at least partially, hypoxia-driven. GP (pushing or not) was the only independent predictor of survival at 2 years. CRC liver metastases grow according to different GP patterns with different angiogenic properties. At 2 years of follow-up a GP with a pushing component was an independent predictor of poor survival, suggesting that the pushing GP is characterized by a more aggressive tumour biology. Further elucidation of the mechanisms and biological pathways involved in and responsible for the differences in GP between CRC liver metastases in different patients might lead to therapeutic agents and strategies taking advantage of this 2 year 'window of opportunity'.

摘要

关于决定结直肠癌(CRC)肝转移预后的生物学特征,人们知之甚少。在之前的工作中,我们报告了 CRC 肝转移瘤-肝界面的三种不同组织学模式,分别称为推动式、替代式和纤维母细胞增生式(GP)。本研究的目的是在一个大的数据集内证实具有不同 GP 的 CRC 肝转移瘤的血管生成和缺氧特性存在差异,并研究 GP 作为预后因素的价值。在 205 例接受 CRC 肝转移切除术的患者中,使用苏木精-伊红和 Gordon Sweet 银染色确定转移瘤的 GP。使用免疫组织化学测定肿瘤细胞增殖分数(TCP%)、内皮细胞增殖分数(ECP%)和碳酸酐酶 9(CA9)的表达。记录标准临床病理数据和总生存期。肝转移瘤的替代、推动、纤维母细胞增生和混合 GP 分别占 27.8%、15.6%、34.6%和 17.6%。TCP%、ECP%和 CA9 表达分析表明,具有替代 GP 的 CRC 肝转移瘤是非血管生成的,而具有推动 GP 的 CRC 肝转移瘤是最具血管生成性的,血管生成至少部分是由缺氧驱动的。GP(推动或不推动)是 2 年生存的唯一独立预测因素。CRC 肝转移瘤根据不同的 GP 模式生长,具有不同的血管生成特性。在 2 年的随访中,具有推动成分的 GP 是生存不良的独立预测因素,这表明推动 GP 的肿瘤生物学更具侵袭性。进一步阐明不同患者 CRC 肝转移瘤之间 GP 差异所涉及的机制和生物学途径,并明确导致 GP 差异的原因,可能会导致利用这 2 年“机会之窗”的治疗药物和策略。

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