Quaas Alexander
Institut für Pathologie, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
Pathologie (Heidelb). 2023 Sep;44(5):287-293. doi: 10.1007/s00292-023-01206-4. Epub 2023 Jun 27.
Colon carcinomas are among the most common malignant tumors worldwide. The critical evaluation of different therapy options is particularly relevant. On the one hand, colon carcinomas more often occur at an older age, on the other hand patients with colon carcinomas often live for decades after initial diagnosis - it is just as important to avoid overtreatment as it is to avoid undertreatment, which shortens the patient's life span. Prognostically effective biomarkers are decision-making tools. There are clinical, molecular, and histological prognostic markers-the latter are presented in this paper.
To present the current state of knowledge on morphologically determinable prognostic markers in colon cancer.
Literature search in PubMed and Medline.
In their daily work, pathologists identify highly relevant prognostic markers that are essential for therapeutic decisions. These markers must be communicated to the clinical colleague. The most important and longest-known prognostic markers are staging (TNM), including local resection status, lymph node involvement and number on the surgical specimen, vascular invasion, perineural sheath infiltration, and histomorphologic growth pattern determination (e.g., micropapillary colon carcinoma is associated with a very unfavorable prognosis). Recently, tumor budding has been added, which has practical applications especially in endoscopically applied pT1 carcinomas ("malignant polyps").
结肠癌是全球最常见的恶性肿瘤之一。对不同治疗方案进行批判性评估尤为重要。一方面，结肠癌更常发生于老年患者；另一方面，结肠癌患者在初次诊断后往往能存活数十年——避免过度治疗与避免治疗不足同样重要，治疗不足会缩短患者寿命。具有预后评估作用的生物标志物是决策工具。有临床、分子和组织学预后标志物，本文介绍的是后者。
介绍目前关于结肠癌形态学可确定的预后标志物的知识现状。
在PubMed和Medline上进行文献检索。
在日常工作中，病理学家可识别出对治疗决策至关重要的高度相关的预后标志物。这些标志物必须传达给临床同事。最重要且最广为人知的预后标志物是分期（TNM），包括局部切除状态、淋巴结受累情况及手术标本上的淋巴结数量、血管侵犯、神经周鞘浸润以及组织形态学生长模式判定（例如，微乳头型结肠癌预后非常差）。最近，肿瘤芽生也被纳入其中，它尤其在经内镜应用的pT1期癌（“恶性息肉”）中有实际应用价值。
