Roseano M, Turoldo A, Balani A, Tonello C, Desinan L, Bussani R
Università degli Studi di Trieste, Istituto di Clinica Chirurgica.
Ann Ital Chir. 1994 May-Jun;65(3):319-29.
The pathological assessment of rectal cancer remained essentially unchanged for 50 years and it is based mainly on Dukes' classification and histological granding. Alternative methods of classifications have also been developed but, actually, Dukes'taging is the most important prognostic factor. The limit of Dukes' classification is the incomplete discrimination between high risk and low risk patients into the same stages. The measurements of cellular DNA content by flow cytometry is emerging as a prognostic aid in many human tumours. Authors analyze on the basis of their experience on 116 curative operations for the cancer of the rectum, the relationship between tumour's features, CEA, symptoms, recurrences, survival, type of operation and DNA flow cytometry. In 100 cases they studied the percentage of cells in "s" phase. (SPF). Samples of flow-cytometry were prepared using paraffin-embedded tumour blocks. The authors didn't find any statistically significant relation among pathological features, staging, ploidy and SPF. Recurrences rate was 16.6% in diploid tumours and 23% in no diploid (p = 0.3). In SPF < 25% it was 18.2% (p = 0.5). 5-year survival was worse in aneuploid patients (p = 0.06). Using Cox' multivariate regression analysis, ploidy has not independent prognostic significance. In conclusion authors consider ploidy a prognostic factor in rectal cancer, but not independent. However, authors conclude that flow cytometry could help in early staging of the disease, especially in preoperative diagnosis. Flow cytometry has a prognostic significance with informations on tumoral biology and could contribute to select patients for adjuvant therapy or different surgical techniques.
直肠癌的病理评估在50年里基本保持不变，主要基于杜克斯分类法和组织学分级。也有其他分类方法被开发出来，但实际上，杜克斯分期是最重要的预后因素。杜克斯分类法的局限性在于，在同一分期中，高风险和低风险患者之间的区分并不完全。通过流式细胞术测量细胞DNA含量在许多人类肿瘤中已成为一种预后辅助手段。作者根据他们对116例直肠癌根治性手术的经验，分析了肿瘤特征、癌胚抗原、症状、复发、生存率、手术类型与DNA流式细胞术之间的关系。在100例病例中，他们研究了处于“s”期的细胞百分比（SPF）。流式细胞术样本是使用石蜡包埋的肿瘤块制备的。作者未发现病理特征、分期、倍体和SPF之间存在任何具有统计学意义的关系。二倍体肿瘤的复发率为16.6%，非二倍体肿瘤的复发率为23%（p = 0.3）。在SPF < 25%的情况下，复发率为18.2%（p = 0.5）。非整倍体患者的5年生存率较差（p = 0.06）。使用考克斯多变量回归分析，倍体没有独立的预后意义。总之，作者认为倍体是直肠癌的一个预后因素，但不是独立的。然而，作者得出结论，流式细胞术有助于疾病的早期分期，尤其是在术前诊断中。流式细胞术具有预后意义，可提供有关肿瘤生物学的信息，并有助于选择辅助治疗或不同手术技术的患者。
