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肿瘤沉积(TD),一种可能被低估的不良预后指标,在III期结肠癌患者的治疗管理中应予以考虑。

[Tumour deposition (TD), a probably underestimated poor prognostic criterion, to be taken into account in the therapeutic management of patients with stage III colon cancer].

作者信息

Delattre Jean-François, Cohen Romain, Emile Jean-François, Bibeau Frédéric, Broudin Chloé, Taieb Julien, André Thierry, Svrcek Magali

机构信息

Sorbonne Université, AP-HP, Service d'Oncologie Médicale, Hôpital Saint-Antoine, Paris, France.

Service d'Anatomie et Cytologie Pathologiques, Hôpital Ambroise Paré (AP-HP), EA4340-BECCOH, Université de Versailles, Université Paris-Saclay, Boulogne, France.

出版信息

Ann Pathol. 2021 Nov;41(6):535-543. doi: 10.1016/j.annpat.2021.09.005. Epub 2021 Oct 16.

Abstract

The management of colorectal cancer (CRC) relies heavily on TNM staging. In order to improve this staging, it is essential to identify all histological markers bearing a significant prognostic value. Among these, tumor deposits (TDs), defined as tumor foci in the pericolonic or perirectal adipose tissue with no residual lymph node tissue, have been shown to be associated with poor prognosis in cohort studies leading to their individualization in the TNM7 classification as pN1c. However, TDs are only considered in the absence of lymph node metastases. There is no consensus on this particular way of integrating TDs in the TNM classification. Indeed, at the time when the choice of the type of adjuvant treatment and its duration in stage III colon cancers (i.e. with lymph node metastases) is based on pT and pN criteria, taking into account TDs only in the absence of concomitant lymph node metastases is potentially responsible for a misclassification of some patients and wrong therapeutic decisions. In addition, many questions concerning the true definition of TDs, their origin, their prognostic value and the optimization of their consideration remain open. The objective of this review is to provide a synthesis of current knowledge on TDs in CRC, in view of their prognostic importance, their biological complexity and the scientific interest they are currently the subject of.

摘要

结直肠癌(CRC)的管理在很大程度上依赖于TNM分期。为了改进这种分期,识别所有具有显著预后价值的组织学标志物至关重要。其中,肿瘤沉积物(TDs)被定义为结肠周围或直肠周围脂肪组织中的肿瘤灶,且无残留淋巴结组织,在队列研究中已显示其与预后不良相关,这导致其在TNM7分类中被个体化定义为pN1c。然而,TDs仅在无淋巴结转移的情况下才被考虑。关于将TDs纳入TNM分类的这种特殊方式,目前尚无共识。实际上,在选择III期结肠癌(即伴有淋巴结转移)的辅助治疗类型及其持续时间时是基于pT和pN标准,仅在无伴随淋巴结转移的情况下考虑TDs可能会导致一些患者分类错误和错误的治疗决策。此外,许多关于TDs的真正定义、起源、预后价值以及对其考量的优化等问题仍然没有答案。鉴于TDs的预后重要性、生物学复杂性以及当前它们所引发的科学兴趣,本综述的目的是对CRC中TDs的现有知识进行综合阐述。

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