肿瘤芽在 IV 期结直肠癌中的预后和预测价值。
Prognostic and predictive values of tumour budding in stage IV colorectal cancer.
机构信息
Department of Surgery, National Defence Medical College, 3-2 Namiki, Tokorozawa, 359-8513, Japan.
出版信息
BJS Open. 2020 Aug;4(4):693-703. doi: 10.1002/bjs5.50300. Epub 2020 May 29.
BACKGROUND
Tumour budding is an important prognostic feature in early-stage colorectal cancer, but its prognostic significance in metastatic disease has not been fully investigated.
METHODS
Patients with stage IV disease who had primary colorectal tumour resection without previous chemotherapy or radiotherapy from January 2000 to December 2018 were reviewed retrospectively. Budding was evaluated at the primary site and graded according to the criteria of the International Tumor Budding Consensus Conference (ITBCC) (BD1, low; BD2, intermediate; BD3, high). Patients were categorized by metastatic (M1a, M1b) and resectional (R0/R1, R2/unresected) status. Subgroups were compared for overall (OS) and recurrence-free (RFS) survival in R0/R1 subgroups; R2/unresected patients were evaluated for the rate of tumour progression, based on change in tumour size from baseline.
RESULTS
Of 371 patients observed during the study, 362 were analysed. Patients with BD3 had a lower 5-year OS rate than those with BD1 + BD2 (18·4 versus 40·5 per cent; P < 0·001). Survival analyses according to metastatic and resection status also showed that BD3 was associated with shorter OS than BD1 + BD2. In multivariable analysis, BD3 (hazard ratio (HR) 1·51, 95 per cent c.i. 1·11 to 2·10; P = 0·009), T4 status (HR 1·39) and R2/unresected status (HR 3·50) were associated with decreased OS. In the R0/R1 subgroup, the 2-year RFS rate was similar for BD3 and BD1 + BD2 according to metastatic status. There was no significant difference between BD3 and BD1 + BD2 for change in tumour size in the R2/unresected subgroup (P = 0·094). Of 141 patients with initially unresectable metastases who had chemotherapy, 35 achieved conversion from unresectable to resectable status. The conversion rate was significantly higher for BD1 + BD2 than for BD3 (36 versus 18 per cent; P = 0·016).
CONCLUSION
Stage IV colorectal cancer with high-grade tumour budding according to ITBCC criteria correlates with poor prognosis.
背景
肿瘤芽殖是早期结直肠癌的一个重要预后特征，但在转移性疾病中的预后意义尚未得到充分研究。
方法
回顾性分析了 2000 年 1 月至 2018 年 12 月期间接受初始结直肠肿瘤切除术且无既往化疗或放疗的 IV 期疾病患者。在原发部位评估芽殖，并根据国际肿瘤芽殖共识会议（ITBCC）标准进行分级（BD1，低；BD2，中；BD3，高）。根据转移性（M1a、M1b）和切除状态（R0/R1、R2/未切除）对患者进行分类。在 R0/R1 亚组中比较总生存期（OS）和无复发生存期（RFS）；根据基线时肿瘤大小的变化，评估 R2/未切除患者的肿瘤进展率。
结果
在研究期间观察到的 371 名患者中，对 362 名患者进行了分析。BD3 患者的 5 年 OS 率低于 BD1+BD2 患者（18.4%对 40.5%；P<0.001）。根据转移和切除状态的生存分析也表明，BD3 与 OS 缩短相关。多变量分析显示，BD3（风险比（HR）1.51，95%置信区间（CI）1.11 至 2.10；P=0.009）、T4 状态（HR 1.39）和 R2/未切除状态（HR 3.50）与 OS 降低相关。在 R0/R1 亚组中，根据转移状态，BD3 和 BD1+BD2 的 2 年 RFS 率相似。在 R2/未切除亚组中，BD3 和 BD1+BD2 的肿瘤大小变化无显著差异（P=0.094）。在最初不可切除转移的 141 名患者中，有 35 名接受化疗后转化为可切除状态。BD1+BD2 的转化率明显高于 BD3（36%对 18%；P=0.016）。
结论
根据 ITBCC 标准，结直肠癌 IV 期伴有高级别肿瘤芽殖与预后不良相关。
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