通过静脉侵犯程度和组织学亚型对结直肠癌术后复发/转移进行风险分层。

Risk stratification for predicting postoperative recurrence/metastasis of colorectal cancer by grade of venous invasion coupled with histological subtype.

机构信息

Department of Diagnostic Pathology, Ota Memorial Hospital, SUBARU Health Insurance Society, 455-1 Oshima, Ota, Gunma, 373-8585, Japan.

Department of Surgery, Shioya Hospital, International University of Health and Welfare, Tochigi, Japan.

出版信息

BMC Gastroenterol. 2022 Feb 23;22(1):79. doi: 10.1186/s12876-022-02163-7.

DOI:10.1186/s12876-022-02163-7

PMID:35197005

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8867649/

Abstract

BACKGROUND

Colorectal cancer (CRC) consists of several histological subtypes that greatly affect prognosis. Venous invasion (VI) has been implicated in the postoperative recurrence of CRC, but the relationship between the VI grade and postoperative recurrence in each histological subtype has not been clarified thus far.

METHODS

A total of 323 CRCs without distant metastasis at surgery (pathologic stage III or lower), including 152 well-to-moderately differentiated adenocarcinomas (WMDAs), 98 poorly differentiated adenocarcinomas (PDAs), and 64 mucinous adenocarcinomas (MUAs), were analyzed. They were routinely processed pathologically, and VI was graded as follows irrespective of location by elastica van Gieson staining: v0 (none), no venous invasion; v1 (mild), 1-3 invasions per glass slide; v2 (moderate), 4-6 invasions per glass slide; and v3 (severe), ≥ 7 invasions per glass slide. Filling-type invasion in veins with a minor axis of ≥ 1 mm increased the grade by 1. The association of VI grade with prognosis was statistically analyzed.

RESULTS

All recurrences occurred as distant metastases. Recurrence increased with VI grade in WMDA (v0 11.8%, v1 15.8%, v2 73.9%, v3 75.0%) and MUA (v0 15.2%, v1 30.8%, v2 40.0%). The recurrence rate was relatively high in PDA even with v0 and increased with VI grade (v0 27.8%, v1 32.7%, v2 33.3%, v3 60.0%). VI grade was a significant predictor of recurrence in WMDA but not in PDA and MUA by multivariate analysis. In node-negative (stage II or lower) CRC, the recurrence-free survival (RFS) rate exceeded 90% in v0 and v1 WMDA until postoperative day (POD) 2100 and v0 MUA until POD 1600 but fell below 80% in the other settings by POD 1000. In node-positive (stage III) CRC, the RFS rate fell below 80% in all histological subtypes by POD 1000.

CONCLUSIONS

VI grade v1 had a similar recurrence rate and RFS as grade v0 and may not warrant adjuvant chemotherapy in node-negative (stage II or lower) WMDA. In addition to node-positive (stage III) CRC, adjuvant chemotherapy may be indicated for node-negative (stage II or lower) CRC when it is WMDA with VI grade v2 or v3, MUA with VI, or PDA.

摘要

背景

结直肠癌（CRC）包含多个对预后影响较大的组织学亚型。静脉侵犯（VI）已被认为与 CRC 的术后复发有关，但 VI 分级与每种组织学亚型的术后复发之间的关系尚未阐明。

方法

分析了 323 例手术时无远处转移（病理分期 III 期或更低）的 CRC，包括 152 例中-高分化腺癌（WMDAs）、98 例低分化腺癌（PDAs）和 64 例黏液腺癌（MUAs）。所有病例均经常规病理处理，通过弹力纤维 Van Gieson 染色对 VI 分级进行评估，无论位置如何，均如下分级：v0（无），无静脉侵犯；v1（轻度），每玻片 1-3 个侵犯；v2（中度），每玻片 4-6 个侵犯；v3（重度），每玻片≥7 个侵犯。静脉内小轴≥1mm 的填充型侵犯将等级提高 1 级。统计分析 VI 分级与预后的关系。

结果

所有复发均为远处转移。在 WMDA（v0 为 11.8%，v1 为 15.8%，v2 为 73.9%，v3 为 75.0%）和 MUA（v0 为 15.2%，v1 为 30.8%，v2 为 40.0%）中，VI 分级越高，复发率越高。即使在 v0 时，PDAs 的复发率也相对较高，且随着 VI 分级的升高而升高（v0 为 27.8%，v1 为 32.7%，v2 为 33.3%，v3 为 60.0%）。多变量分析显示，VI 分级是 WMDA 但不是 PDA 和 MUA 复发的显著预测因素。在淋巴结阴性（II 期或更低）CRC 中，v0 和 v1 的 WMDA 直到术后第 2100 天，v0 的 MUA 直到术后第 1600 天，无复发生存率（RFS）率超过 90%，但在其他情况下，v0 和 v1 的 WMDA 直到术后第 1000 天，RFS 率低于 80%。在淋巴结阳性（III 期）CRC 中，所有组织学亚型在术后第 1000 天的 RFS 率均低于 80%。