Tanaka S, Martling A, Lindholm J, Holm T, Palmer G
Department of Molecular Medicine and Surgery, Karolinska Institutet, SE-171 76 Stockholm, Sweden; Department of Surgery, Matsuda Colo-Proctology Center, 753 Irino-cho, Hamamatsu, Shizuoka 4328061, Japan.
Department of Molecular Medicine and Surgery, Karolinska Institutet, SE-171 76 Stockholm, Sweden.
Eur J Surg Oncol. 2015 Sep;41(9):1204-9. doi: 10.1016/j.ejso.2015.05.019. Epub 2015 Jun 12.
To analyse the incidence and distribution of remaining cancer cells within the fibrosis induced by preoperative chemo-radiotherapy (CRT) for locally advanced rectal cancer.
The histopathological specimens from 46 patients operated on with extensive surgery for locally advanced rectal cancer after CRT were examined. The extension of fibrosis in relation to the mesorectal fascia (MRF) and the distribution of cancer cells within the fibrosis was examined using routine haematoxylin-eosin staining. In addition, immunohistochemical staining with CK20 was done to examine if cancer cells were missed by routine pathological work up.
All specimens showed CRT induced fibrosis. Two specimens showed complete response without viable cancer cells (ypT0). The fibrosis was limited inside the MRF in three cases, adherent to or involved the MRF in ten cases and in 33 cases the fibrosis was obvious outside as well as inside the fascia. Twenty-one cases showed fibrosis on the surgical resection margin, and in 9 of these cancer cells were found on the surgical margin (R1, R2-resection). 37 patients had R0 resections and among those 24 showed fibrosis beyond the MFR and 13 had scattered cancer cells in the fibrosis along or outside the MRF.
The rate of remaining cancer cells within the fibrosis was high in patients with locally advanced rectal cancer treated with CRT. Frequently cancer cells were detected near the border of the fibrosis. A complete resection of the fibrosis is therefore recommended to achieve an R0 resection after neo-adjuvant treatment.
分析术前放化疗（CRT）治疗局部晚期直肠癌所诱导的纤维化内残留癌细胞的发生率及分布情况。
对46例接受CRT后行广泛手术治疗的局部晚期直肠癌患者的组织病理学标本进行检查。使用常规苏木精-伊红染色检查纤维化相对于直肠系膜筋膜（MRF）的延伸情况以及纤维化内癌细胞的分布。此外，进行细胞角蛋白20（CK20）免疫组化染色，以检查常规病理检查是否遗漏癌细胞。
所有标本均显示CRT诱导的纤维化。2个标本显示完全缓解，无存活癌细胞（ypT0）。3例纤维化局限于MRF内，10例纤维化粘连或累及MRF，33例纤维化在筋膜内外均明显。21例手术切缘有纤维化，其中9例在手术切缘发现癌细胞（R1、R2切除）。37例患者行R0切除，其中24例纤维化超出MFR，13例在沿MRF或其外侧的纤维化中有散在癌细胞。
CRT治疗的局部晚期直肠癌患者纤维化内残留癌细胞的发生率较高。癌细胞常出现在纤维化边界附近。因此，建议在新辅助治疗后完全切除纤维化以实现R0切除。
