Williams N S, Durdey P, Quirke P, Robinson P J, Dyson J E, Dixon M F, Bird C C
Br J Surg. 1985 Nov;72(11):868-74. doi: 10.1002/bjs.1800721106.
A sophisticated staging technique (extended staging, ES) employing modern technology has been compared prospectively with conventional clinical assessment (initial staging, IS) in 45 patients with low rectal carcinoma (less than 12 cm from the anal verge) to determine its potential merit and its impact on clinical management. ES consisted of computerized tomography of liver and pelvis, ultrasound scan of liver, measurement of serum concentrations of carcinoembryonic antigen (CEA) and acute phase reactant proteins and multiple superficial and deep biopsies to determine not only the histological grade of the tumour but also its DNA cellular content as measured by flow cytometry. ES proved statistically superior to IS in the assessment of local spread and dissemination. Although histological grade proved to be more accurate on ES than IS this was only true when one specialist pathologist interpreted the slides. When several pathologists were involved interobserver variation made interpretation unreliable. Assessment of DNA content using flow cytometry, being quantitative, was more accurate and perhaps should be used in the future as a prognostic indicator. The improved accuracy of ES would have altered both pre- and intra-operative clinical decisions. It would have prevented some patients receiving inappropriate adjuvant therapy as well as selecting patients more accurately for the correct treatment.
一项采用现代技术的先进分期技术（扩展分期，ES）已在45例低位直肠癌（距肛缘小于12 cm）患者中与传统临床评估（初始分期，IS）进行了前瞻性比较，以确定其潜在优势及其对临床管理的影响。ES包括肝脏和骨盆的计算机断层扫描、肝脏超声扫描、癌胚抗原（CEA）和急性期反应蛋白血清浓度的测定以及多次浅表和深部活检，不仅用于确定肿瘤的组织学分级，还用于通过流式细胞术测量其DNA细胞含量。在评估局部扩散和播散方面，ES在统计学上优于IS。虽然组织学分级在ES上比在IS上更准确，但只有当一位专科病理学家解读切片时才是如此。当有几位病理学家参与时，观察者间的差异使得解读不可靠。使用流式细胞术评估DNA含量是定量的，更准确，也许将来应作为预后指标使用。ES准确性的提高会改变术前和术中的临床决策。它可以防止一些患者接受不适当的辅助治疗，并更准确地为患者选择正确的治疗方法。
