探讨组织病理学标志物在结直肠腺癌预后亚组区分中的新应用。

Novel applications of histopathological markers to distinguish prognostic subgroups in colorectal adenocarcinoma.

机构信息

Department of Pathology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

出版信息

Ann Med. 2023;55(2):2244181. doi: 10.1080/07853890.2023.2244181.

DOI:10.1080/07853890.2023.2244181

PMID:37557892

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10413918/

Abstract

OBJECTIVE

To explore the novel applications of histological factors by stratifying the prognostic markers of the overall CRC patients in subgroups.

MATERIALS AND METHODS

A total of 17 histopathological and molecular factors were retrospectively collected and systematically analyzed for the prediction of CRC prognosis in the overall and stratified subgroups by using the Kaplan-Meier curve analysis as well as the Cox regression test. The χ test was used to analyze the correlation of the prognostic markers with other factors.

RESULTS

The histopathological markers including the lymph node metastasis (LNM), perineural/venous invasion (PVI), TNM stage, the local recurrence or distant metastasis after surgery (R/M) and the molecular markers Ki-67 expression as well as KRAS mutation were identified to be the independent prognostic biomarkers in the overall CRC. The differential prognosis of LNM was found to be significant in age, tumor site, histological classification (histo_classification), cell differentiation, and KRAS/NRAS/BRAF (KNB) mutation stratified subgroups. The PVI was discovered to differently predict survival for patients in age, histo_classification, differentiation, and R/M stratified subgroups. Same as LNM and PVI, TNM was also found to demonstrate differential prognosis in age, tumor site, histo_classification, differentiation, R/M status and KRAS/KNB mutation stratified subgroups. More importantly, R/M was firstly identified not to be terrible for patients in age, histo_classification, LNM, TNM, Ki-67, and KRAS/KNB stratified subgroups. Besides, KRAS mutation was innovatively found to show differential prognosis in age, differentiation, and LNM stratified subgroups.

CONCLUSIONS

The stratification analyses of prognostic markers in CRC patients indicate novel applications of the above histopathological and molecular markers in clinic and the findings provide new insights into future investigations of precision pathology.

摘要

目的

通过分层分析整体 CRC 患者的预后标志物，探索组织学因素的新应用。

材料和方法

回顾性收集了 17 种组织病理学和分子因素，并通过 Kaplan-Meier 曲线分析和 Cox 回归检验对整体和分层亚组中 CRC 预后的预测进行了系统分析。χ 检验用于分析预后标志物与其他因素的相关性。

结果

组织病理学标志物包括淋巴结转移（LNM）、神经/脉管侵犯（PVI）、TNM 分期、手术后局部复发或远处转移（R/M）以及分子标志物 Ki-67 表达和 KRAS 突变被确定为整体 CRC 的独立预后生物标志物。LNM 的差异预后在年龄、肿瘤部位、组织学分类（histo_classification）、细胞分化和 KRAS/NRAS/BRAF（KNB）突变分层亚组中具有显著意义。发现 PVI 在年龄、histo_classification、分化和 R/M 分层亚组中不同地预测患者的生存。与 LNM 和 PVI 一样，TNM 也在年龄、肿瘤部位、组织学分类、分化、R/M 状态和 KRAS/KNB 突变分层亚组中表现出不同的预后。更重要的是，首次发现 R/M 对年龄、组织学分类、LNM、TNM、Ki-67 和 KRAS/KNB 分层亚组中的患者并不可怕。此外，KRAS 突变在年龄、分化和 LNM 分层亚组中表现出不同的预后。