Institute of Pathology, Klinikum Bayreuth, 95445 Bayreuth, Germany.
Institute of Pathology, Klinikum Bayreuth, 95445 Bayreuth, Germany.
Hum Pathol. 2019 Jul;89:81-89. doi: 10.1016/j.humpath.2019.04.006. Epub 2019 May 3.
Grading for colorectal carcinoma (CRC) is traditionally based on the percentage of gland formation. In recent years, high-grade CRC has become subject to more precise molecular grading strategies. Most, however, are low-grade cases according to the World Health Organization (WHO) with inhomogenous outcomes due to still insufficient characterization. On the other hand, budding and tumor-infiltrating lymphocytes have developed as interesting additive prognostic factors in CRC. Especially budding has been very well defined by the International Tumor Budding Consensus Conference recently. We analyzed a large collective of 576 WHO low-grade CRC cases, stages I to IV, diagnosed between 2005 and 2016 in terms of gland formation, budding, and tumor-infiltrating lymphocytes and developed a new, morphology-based risk score, taking into account each of the 3 parameters. For each parameter, 1 to 2 points were given, resulting in a sum score, dividing the CRC cases into a low-, an intermediate-, and a high-risk group. By our score, 179 (34.9%) of the cases were grouped as low risk, 241 (53.5) as intermediate risk, and 92 (35.5%) as high risk. The 3 groups differed significantly in pT, pN, and M as well as tumor stages, lymphatic vessel invasion, venous invasion, and overall survival (0.;P < .001 for low risk versus high risk, P = .038 for low versus intermediate risk, and P = .036 for intermediate versus high risk; log rank: median, 94.0 months [95% confidence interval {CI}, 74.9-113.1] for low risk; median, 63.0 months [95% CI, 44.0-82.0] for intermediate risk; and median, 40.0 months [95% CI, 23.4-56.7] for high risk) in Kaplan-Meier-analysis. Our proposed Bayreuth score enables separating the large group of WHO low-grade CRC cases into subgroups, which differ significantly in outcome.
结直肠癌（CRC）的分级传统上基于腺体形成的百分比。近年来，高级别 CRC 已成为更精确的分子分级策略的主题。然而，根据世界卫生组织（WHO）的标准，大多数病例为低级别，由于特征描述仍然不足，因此结果存在异质性。另一方面，芽生和肿瘤浸润淋巴细胞已成为 CRC 中有趣的附加预后因素。特别是芽生，最近已被国际肿瘤芽生共识会议很好地定义。我们分析了 2005 年至 2016 年间诊断为 I 期至 IV 期的 576 例 WHO 低级别 CRC 病例，从腺体形成、芽生和肿瘤浸润淋巴细胞的角度进行了分析，并开发了一种新的基于形态的风险评分，考虑到 3 个参数中的每一个。对于每个参数，给予 1 到 2 分，得到一个总和评分，将 CRC 病例分为低风险、中风险和高风险组。根据我们的评分，179 例（34.9%）病例为低风险组，241 例（53.5%）为中风险组，92 例（35.5%）为高风险组。这 3 组在 pT、pN 和 M 以及肿瘤分期、淋巴管浸润、静脉浸润和总生存方面存在显著差异（0.;低风险与高风险相比，P <.001，低风险与中风险相比，P =.038，中风险与高风险相比，P =.036；对数秩：低风险的中位生存时间为 94.0 个月[95%置信区间（CI），74.9-113.1]；中风险的中位生存时间为 63.0 个月[95%CI，44.0-82.0]；高风险的中位生存时间为 40.0 个月[95%CI，23.4-56.7]）。在 Kaplan-Meier 分析中。我们提出的拜罗伊特评分能够将大量的 WHO 低级别 CRC 病例分为亚组，这些亚组在结局上存在显著差异。
