Fonseca Gilton M, de Mello Evandro S, Faraj Sheila F, Kruger Jaime A P, Coelho Fabricio F, Jeismann Vagner B, Lupinacci Renato M, Cecconello Ivan, Alves Venancio A F, Pawlik Timothy M, Herman Paulo
Digestive Surgery Division, Liver Surgery Unit, Department of Gastroenterology, University of Sao Paulo Medical School, São Paulo, Brazil.
Department of Pathology, University of Sao Paulo Medical School, São Paulo, Brazil.
J Surg Oncol. 2018 Jun;117(7):1364-1375. doi: 10.1002/jso.25017. Epub 2018 Feb 15.
Histomorphological features have been described as prognostic factors after resection of colorectal liver metastases (CLM). The objectives of this study were to assess the prognostic significance of tumor budding (TB) and poorly differentiated clusters (PDC) among CLM, and their association with other prognostic factors.
We evaluated 229 patients who underwent a first resection of CLM. Slides stained by HE were assessed for TB, PDC, tumor border pattern, peritumoral pseudocapsule, peritumoral, and intratumoral inflammatory infiltrate. Lymphatic and portal invasion were evaluated through D2-40 and CD34 antibody.
Factors independently associated with poor overall survival were nodules>4 (P = 0.002), presence of PDC G3 (P = 0.007), portal invasion (P = 0.005), and absence of tumor pseudocapsule (P = 0.006). Factors independently associated with disease-free survival included number of nodules>4 (P < 0.001), presence of PDC G3 (P = 0.005), infiltrative border (P = 0.031), portal invasion (P = 0.006), and absent/mild peritumoral inflammatory infiltrate (P = 0.002). PDC and TB were also associated with histological factors, as portal invasion (TB), peritumoral inflammatory infiltration (PDC), infiltrative border, and absence of tumor pseudocapsule (TB and PDC).
This is the first study demonstrating PDC as a prognostic factor in CLM. TB was also a prognostic factor, but it was not an independent predictor of survival.
组织形态学特征已被描述为结直肠癌肝转移（CLM）切除术后的预后因素。本研究的目的是评估CLM中肿瘤芽生（TB）和低分化簇（PDC）的预后意义，以及它们与其他预后因素的关联。
我们评估了229例行首次CLM切除术的患者。对苏木精-伊红（HE）染色的切片进行TB、PDC、肿瘤边界模式、瘤周假包膜、瘤周和瘤内炎性浸润的评估。通过D2-40和CD34抗体评估淋巴管和门静脉侵犯情况。
与总生存期差独立相关的因素有结节>4个（P = 0.002）、存在G3级PDC（P = 0.007）、门静脉侵犯（P = 0.005）和无肿瘤假包膜（P = 0.006）。与无病生存期独立相关的因素包括结节>4个（P < 0.001）、存在G3级PDC（P = 0.005）、浸润性边界（P = 0.031）、门静脉侵犯（P = 0.006）和无/轻度瘤周炎性浸润（P = 0.002）。PDC和TB也与组织学因素相关，如门静脉侵犯（TB）、瘤周炎性浸润（PDC）、浸润性边界和无肿瘤假包膜（TB和PDC）。
这是第一项证明PDC是CLM预后因素的研究。TB也是一个预后因素，但它不是生存的独立预测指标。
