Lee Victor Wai Kwan, Chan Kui Fat
Department of Clinical Pathology, Tuen Mun Hospital, Hong Kong.
Department of Clinical Pathology, Tuen Mun Hospital, Hong Kong.
Pathol Res Pract. 2018 Mar;214(3):402-407. doi: 10.1016/j.prp.2017.12.019. Epub 2018 Jan 2.
Comparison between tumor budding (TB) and poorly-differentiated clusters (PDC) for prognostication in Stage II colon cancer was not extensively studied in literature. In this retrospective study, we assessed TB (according to the consensus statement in 2016) and PDC in 135 Stage II colon adenocarcinoma resection specimens. Counting of TB and PDC was performed on H&E slides. High-grade TB (Bd3 (≥10 tumor buds in 0.785 mm)) and high-grade PDC (Grade 3 (≥10)) were found in 20% and 17% of cases respectively. High-grade TB was associated with pT4 (p = 0.008) and presence of lymphovascular invasion (p = 0.001). There was correlation between TB and PDC grades (p < 0.001), in which both grades were the same or one grade apart in majority of the cases (95%). Both TB and PDC correlated with 5-year disease-specific survival (DSS) and overall survival (OS) (DSS for TB: 89% (Bd1); 73% (Bd2); 52% (Bd3), p = 0.001) (DSS for PDC: 88% (Grade 1); 72% (Grade 2); 61% (Grade 3), p = 0.021). Survival curves of Stage II colon cancer could be further stratified by TB and PDC (log-rank tests: TB p < 0.001; PDC p = 0.009). Combining TB and PDC grades into single grading system (high-grade: Bd3 + G2, Bd2 + G3, Bd3 + G3; low-grade: other combinations) was found to have strong correlation with both 5-year DSS and OS (both p < 0.001). Our study has confirmed TB and PDC as independent prognostic factors in Stage II colon cancer, and might help selecting high-risk patients for adjuvant chemotherapy.
关于肿瘤芽生（TB）与低分化簇（PDC）在Ⅱ期结肠癌预后评估中的比较，文献中尚未进行广泛研究。在这项回顾性研究中，我们评估了135例Ⅱ期结肠腺癌切除标本中的肿瘤芽生（根据2016年的共识声明）和低分化簇。在苏木精-伊红（H&E）染色切片上进行肿瘤芽生和低分化簇的计数。分别在20%和17%的病例中发现高级别肿瘤芽生（Bd3（0.785平方毫米内≥10个肿瘤芽））和高级别低分化簇（3级（≥10））。高级别肿瘤芽生与pT4（p = 0.008）和淋巴管侵犯的存在（p = 0.001）相关。肿瘤芽生和低分化簇分级之间存在相关性（p < 0.001），在大多数病例（95%）中，两者分级相同或相差一级。肿瘤芽生和低分化簇均与5年疾病特异性生存（DSS）和总生存（OS）相关（肿瘤芽生的DSS：89%（Bd1）；73%（Bd2）；52%（Bd3），p = 0.001）（低分化簇的DSS：88%（1级）；72%（2级）；61%（3级），p = 0.021）。Ⅱ期结肠癌的生存曲线可通过肿瘤芽生和低分化簇进一步分层（对数秩检验：肿瘤芽生p < 0.001；低分化簇p = 0.009）。将肿瘤芽生和低分化簇分级合并为单一分级系统（高级别：Bd3 + G2、Bd2 + G3、Bd3 + G3；低级别：其他组合）被发现与5年疾病特异性生存和总生存均有很强的相关性（两者p < 0.001）。我们的研究证实肿瘤芽生和低分化簇是Ⅱ期结肠癌的独立预后因素，可能有助于选择辅助化疗的高危患者。
