结直肠癌患者中倍体、细胞增殖动力学及传统临床病理标准的预后价值：一项前瞻性研究。

Prognostic value of ploidy, cell proliferation kinetics, and conventional clinicopathologic criteria in patients with colorectal carcinoma: a prospective study.

作者信息

Pietra N, Sarli L, Sansebastiano G, Jotti G S, Peracchia A

机构信息

Institute of General Surgery, University of Parma, School of Medicine, Italy.

出版信息

Dis Colon Rectum. 1996 May;39(5):494-503. doi: 10.1007/BF02058700.

DOI:10.1007/BF02058700

PMID:8620797

Abstract

PURPOSE

The aim of this study was to obtain additional biologic determinants that may be of use in segregating into subgroups with different prognosis patients with similarly staged colorectal cancers.

METHODS

Between 1989 and 1991, a prospective study of prognostic factors has been performed in a group of 98 consecutive, unselected patients who underwent curative resections for primary untreated large bowel carcinoma. The fate of all patients is known at three years after operation. Clinical and pathologic data were recorded at the time of presentation and operation, and patients have been the subjects of regular follow-up. Tumor DNA content was determined by flow cytometry, and cell proliferative activity was determined by autoradiography with tritiated thymidine labeling index (LI).

RESULTS

Univariate analysis revealed that the most important predictors of survival (P < 0.001) were the presence of positive lymph nodes, the presence of preoperative complications, Dukes stage, and LI. The multivariate analysis showed that Dukes stage (P < 0.002) and LI (P < 0.0001) were the only factors significantly related to survival. Disease-free survival was influenced significantly by Dukes stage (P < 0.001), LI, according to the classification in the two groups of high and low proliferative activity, respectively, (P < 0.0001), LI, calculated as a continuous variable (P < 0.0002), and the presence of lymph node metastases (P < 0.003). Outcome (favorable/unfavorable) was influenced significantly by Dukes stage (P < 0.0001) and LI (P < 0.0001). Concordance for each patient between Dukes stage and outcome was 73.1 percent and between LI, calculated as a continuous variable, and outcome was 74.1 percent. If, on the other hand, Dukes stage and LI are used together, concordance with outcome reaches 89.2 percent.

CONCLUSION

We can conclude that, from a practical point of view, LI is an essential factor that must be combined with pathologic variables for a better prediction of patient outcome.

摘要

目的

本研究的目的是获取更多生物学决定因素，这些因素可能有助于将分期相似的结直肠癌患者分为具有不同预后的亚组。

方法

1989年至1991年间，对一组98例连续、未经选择的原发性未治疗大肠癌患者进行了根治性切除，并对其预后因素进行了前瞻性研究。所有患者术后三年的转归情况均已知。在就诊和手术时记录临床和病理数据，患者接受定期随访。通过流式细胞术测定肿瘤DNA含量，通过用氚标记胸腺嘧啶核苷标记指数（LI）的放射自显影法测定细胞增殖活性。

结果

单因素分析显示，生存的最重要预测因素（P < 0.001）为阳性淋巴结的存在、术前并发症的存在、Dukes分期和LI。多因素分析表明，Dukes分期（P < 0.002）和LI（P < 0.0001）是与生存显著相关的唯一因素。无病生存期分别受Dukes分期（P < 0.001）、根据高增殖活性和低增殖活性两组分类的LI（P < 0.0001）、作为连续变量计算的LI（P < 0.0002）以及淋巴结转移的存在（P < 0.003）的显著影响。结局（良好/不良）受Dukes分期（P < 0.0001）和LI（P < 0.0001）的显著影响。Dukes分期与结局之间的患者一致性为73.1%，作为连续变量计算的LI与结局之间的一致性为74.1%。另一方面，如果将Dukes分期和LI一起使用，与结局的一致性达到89.2%。