Jessberger Jonas, Erlenbach-Wünsch Katharina, Posselt Rebecca, Haderlein Marlen, Agaimy Abbas, Fietkau Rainer, Hartmann Arndt, Distel Luitpold
Department of Radiation Oncology, University Hospital of Erlangen, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany.
Institute of Pathology of the Universitätsklinikum Erlangen, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany.
J Dig Dis. 2017 May;18(5):283-291. doi: 10.1111/1751-2980.12471.
To analyze the prognostic effect of E-cadherin expression, the growth pattern of the tumor and the regression grade in a rectal cancer cohort treated with neoadjuvant radiochemotherapy (RCT).
A total of 223 patients with rectal cancer treated with neoadjuvant RCT followed by surgery were included. Altogether 88 biopsies prior to RCT and 213 tumor resections in an average of 55 days post-RCT were investigated. Protein expression of E-cadherin and tumor growth pattern (solid glandular vs single-cell pattern) was assessed by staining tissue microarrays. The regression grade at the invasion front was determined according to the Dworak scale.
There was a significant decrease of E-cadherin expression (P = 0.002) and a significant increased single-cell growth (P < 0.001) at the invasion front in tumor samples after RCT compared with primary biopsies of the tumor. A low E-cadherin expression in the biopsy was related to a longer metastasis-free survival (P = 0.033) and tumor-specific survival (P = 0.030). Post-RCT single-cell growth at the tumor invasion front was a prognostic factor for longer tumor-specific survival (P = 0.021). A combination of growth pattern and the Dworak regression grade was an independent prognostic parameter for tumor-specific survival (P = 0.015).
Loss of E-cadherin protein expression in the pretreatment biopsy of rectal cancer is associated with fewer metastases and improved survival. Furthermore, the growth pattern in the post-RCT resection specimen has a prognostic value for survival. A combination of growth pattern and tumor regression score (the RegPat score) showed the highest discriminatory power to identify high-risk patients.
分析E-钙黏蛋白表达、肿瘤生长模式及退缩分级对接受新辅助放化疗（RCT）的直肠癌队列患者预后的影响。
纳入223例接受新辅助RCT后行手术治疗的直肠癌患者。共调查了RCT前的88份活检样本以及RCT后平均55天的213份肿瘤切除样本。通过组织微阵列染色评估E-钙黏蛋白的蛋白表达及肿瘤生长模式（实体腺型与单细胞型）。根据德沃拉克量表确定肿瘤浸润前沿的退缩分级。
与肿瘤原发活检样本相比，RCT后肿瘤样本浸润前沿的E-钙黏蛋白表达显著降低（P = 0.002），单细胞生长显著增加（P < 0.001）。活检中E-钙黏蛋白低表达与更长的无转移生存期（P = 0.033）和肿瘤特异性生存期（P = 0.030）相关。RCT后肿瘤浸润前沿的单细胞生长是更长肿瘤特异性生存期的预后因素（P = 0.021）。生长模式与德沃拉克退缩分级的组合是肿瘤特异性生存期的独立预后参数（P = 0.015）。
直肠癌术前活检中E-钙黏蛋白蛋白表达缺失与转移减少及生存期改善相关。此外，RCT后切除标本中的生长模式对生存期具有预后价值。生长模式与肿瘤退缩评分（RegPat评分）的组合在识别高危患者方面显示出最高的鉴别能力。
