Sugamura K, Makino M, Kaibara N
First Department of Surgery, Faculty of Medicine, Tottori University, Yonago, Japan.
Surg Today. 1998;28(2):145-50. doi: 10.1007/s005950050096.
We investigated the occurrence of apoptotic cell death in 104 colorectal carcinomas by terminal-deoxynucleotidyl-transferase-mediated dUTP-diotin nick end-labeling (TUNEL) to determine whether apoptosis could be a useful prognostic factor. The apoptotic index (AI) was calculated as the percentage of positive cancer cells per 1,000 cancer cells, the median AI being 4.1, with a range of 1.9-4.7. Apoptosis was less frequently observed in tumors with higher malignant potential, such as those at advanced stages Dukes B, C and D, than those at Dukes stage A (P < 0.05); in tumors showing evidence of moderate differentiation than in well-differentiated tumors (P < 0.05); and in tumors with venous invasion or lymph node metastasis than in those without these features (P < 0.05). Moreover, the subgroup of patients with a low AI of < 4.1 had a significantly poorer survival rate than the subgroup with a high AI in tumors at Dukes stage C, the 5-year survival rates being 33% vs 68% (P < 0.05; Cox-Mantel). Our findings suggest that less apoptosis might result in a greater progression of colorectal carcinoma, and that the rate of apoptosis might be an indicator of the degree of malignancy. Thus it would appear that the frequency of apoptosis in tumor cells could be a useful prognostic factor in colorectal carcinoma.
我们采用末端脱氧核苷酸转移酶介导的dUTP-生物素缺口末端标记法（TUNEL）对104例结肠直肠癌进行凋亡性细胞死亡的研究，以确定凋亡是否可作为一个有用的预后因素。凋亡指数（AI）计算为每1000个癌细胞中阳性癌细胞的百分比，AI中位数为4.1，范围为1.9 - 4.7。与Dukes A期肿瘤相比，在具有较高恶性潜能的肿瘤中，如Dukes B、C和D期的晚期肿瘤，凋亡现象较少见（P < 0.05）；在中度分化的肿瘤中比高分化肿瘤中少见（P < 0.05）；在有静脉侵犯或淋巴结转移的肿瘤中比无这些特征的肿瘤中少见（P < 0.05）。此外，在Dukes C期肿瘤中，AI < 4.1的低AI患者亚组的生存率明显低于高AI患者亚组，5年生存率分别为33%和68%（P < 0.05；Cox-Mantel检验）。我们的研究结果表明，较少的凋亡可能导致结肠直肠癌进展更严重，且凋亡率可能是恶性程度的一个指标。因此，肿瘤细胞中的凋亡频率似乎可能是结肠直肠癌中一个有用的预后因素。
