Cianchi F, Messerini L, Palomba A, Boddi V, Perigli G, Pucciani F, Bechi P, Cortesini C
Clinica Chirurgica Generale, Universita' di Firenze, Florence, Italy.
Dis Colon Rectum. 1997 Oct;40(10):1170-5; discussion 1175-6. doi: 10.1007/BF02055162.
The clinical significance and prognostic value of the histopathologic parameters used in both the Dukes and Jass classifications were evaluated to select those with an independent effect on survival after radical surgery for colorectal cancer.
The depth of local spread (limited to the bowel wall or extended beyond it), the number of metastatic lymph nodes (none, 1-4, more than 4), the character of the invasive margin (pushing or infiltrating), and the presence or absence of conspicuous peritumoral lymphocytic infiltration were assessed in 235 patients who had undergone radical resection for colorectal cancer. The influence of these variables on survival was studied by univariate and multivariate analysis.
No significant difference in survival was found between patients with conspicuous peritumoral infiltrate and those without it; moreover, multivariate analysis failed to show any independent prognostic value for either lymphocytic infiltration or depth of local invasion. However, the character of the invasive margin and the number of metastatic lymph nodes were identified as the only variables with any independent importance on survival. Based on these data, a new prognostic model may be proposed; it uses the character of the infiltrative margin as a discriminating factor among patients within the lymph node-negative (Dukes A and B stages) and lymph node-positive (Dukes C1 and C2 subsets) groups. A good prognosis for Dukes A, B, and C1 patients was associated with pushing tumors; C1 and C2 patients with infiltrating tumors had a poor prognosis. On the whole, the new prognostic model has allowed for the placement of 59.6 percent of our patients into groups that provide a confident prognosis. The clinical outcome of Dukes A and B patients with infiltrating tumors is still uncertain.
The character of the invasive margin is an important prognostic factor in colorectal cancer. The association of this parameter with the traditional Dukes classification may provide additional useful prognostic information and aid in the selection of those patients who could most benefit from adjuvant therapy.
评估Dukes和Jass分类中所使用的组织病理学参数的临床意义和预后价值，以筛选出对结直肠癌根治术后生存有独立影响的参数。
对235例行结直肠癌根治性切除术的患者，评估其局部扩散深度（局限于肠壁或超出肠壁）、转移淋巴结数量（无、1 - 4个、超过4个）、浸润边缘特征（推挤性或浸润性）以及肿瘤周围是否存在明显的淋巴细胞浸润。通过单因素和多因素分析研究这些变量对生存的影响。
肿瘤周围有明显浸润的患者与无明显浸润的患者在生存方面无显著差异；此外，多因素分析未显示淋巴细胞浸润或局部浸润深度具有任何独立的预后价值。然而，浸润边缘特征和转移淋巴结数量被确定为对生存具有任何独立重要性的唯一变量。基于这些数据，可提出一种新的预后模型；它将浸润边缘特征作为淋巴结阴性（Dukes A和B期）和淋巴结阳性（Dukes C1和C2亚组）患者群体中的鉴别因素。Dukes A、B和C1期患者中，推挤性肿瘤预后良好；C1和C2期浸润性肿瘤患者预后较差。总体而言，新的预后模型已使我们59.6%的患者被归入能提供可靠预后的组别。Dukes A和B期浸润性肿瘤患者的临床结局仍不确定。
浸润边缘特征是结直肠癌的重要预后因素。该参数与传统Dukes分类的关联可能提供额外有用的预后信息，并有助于选择那些最能从辅助治疗中获益的患者。
