Paspatis G A, Zizi A, Chlouverakis G J, Giannikaki E S, Vasilakaki T, Elemenoglou I, Karamanolis D G
Department of Gastroenterology, Benizelion General Hospital, Heraklion-Crete, Greece.
Am J Gastroenterol. 1998 Sep;93(9):1472-7. doi: 10.1111/j.1572-0241.1998.00466.x.
We sought to determine whether the evaluation of rectal cell proliferation in routinely processed rectal biopsies of apparently normal mucosa can predict the presence of advanced colonic neoplasms.
Fifty consecutive patients, who did not meet any of the following exclusion criteria, underwent total colonoscopy. Patients with nonadvanced adenomas, inflammatory bowel disease, hereditary predisposition to colonic cancer, or a history of colonic neoplasms were excluded. Patients with neoplasms in the distal 40 cm of the large bowel were also excluded. An adenoma was considered advanced if it had a diameter > 1 cm, or villous or severe dysplasia histology were present. In 26 of the 50 patients (Group A: 16 men, 10 women; mean age, 65 yr) advanced colonic neoplasms (advanced adenomas or cancer) were detected; in the remaining 24 (Group B: 13 men, 11 women; mean age, 66 yr) the large bowel was free of neoplasms. In all patients the proliferative patterns of apparently normal rectal mucosa were evaluated using the monoclonal antibody MIB-1 to assess the expression of Ki-67 antigen in routinely processed tissues. Proliferation index for the entire crypt, as well as proliferation indices for each of the five equal compartments, into which the crypt had been divided longitudinally, were calculated for each patient.
The mean proliferation indices were similar between the two groups compared. The mean proliferation index for the upper crypt compartments (4 + 5) in the Group A patients was significantly higher than for those of the Group B patients (p < 0.01). Multivariate stepwise logistic regression analysis revealed that among gender, age, and proliferative parameters, the pattern of cell proliferation in the upper rectal crypt (4 + 5) compartment was the only predictor of advanced colonic neoplasms (beta = 11.01, p < 0.001).
Our data suggest that the evaluation of the upward expansion of the rectal crypt proliferative zone in routinely processed rectal biopsies of apparently normal mucosa appears to predict the presence of advanced colonic neoplasms. These preliminary results should be confirmed in larger studies.
我们试图确定在常规处理的外观正常黏膜的直肠活检中评估直肠细胞增殖是否能够预测晚期结肠肿瘤的存在。
50例连续患者接受了全结肠镜检查，这些患者不符合以下任何一项排除标准。排除患有非晚期腺瘤、炎症性肠病、结肠癌遗传易感性或结肠肿瘤病史的患者。也排除大肠远端40 cm内有肿瘤的患者。如果腺瘤直径>1 cm，或存在绒毛状或严重发育异常组织学，则认为该腺瘤为晚期。50例患者中的26例（A组：16例男性，10例女性；平均年龄65岁）检测到晚期结肠肿瘤（晚期腺瘤或癌症）；其余24例（B组：13例男性，11例女性；平均年龄66岁）大肠无肿瘤。在所有患者中，使用单克隆抗体MIB-1评估外观正常直肠黏膜的增殖模式，以评估Ki-67抗原在常规处理组织中的表达。计算每位患者整个隐窝的增殖指数，以及隐窝纵向分为的五个相等部分中每个部分的增殖指数。
两组之间比较的平均增殖指数相似。A组患者隐窝上部区域（4+5）的平均增殖指数显著高于B组患者（p<0.01）。多因素逐步逻辑回归分析显示，在性别、年龄和增殖参数中，直肠隐窝上部（4+5）区域的细胞增殖模式是晚期结肠肿瘤的唯一预测因素（β=11.01，p<0.001）。
我们的数据表明，在常规处理的外观正常黏膜的直肠活检中评估直肠隐窝增殖区的向上扩展似乎可以预测晚期结肠肿瘤的存在。这些初步结果应在更大规模的研究中得到证实。
