Enríquez J M, Díez M, Tobaruela E, Lozano O, Domínguez P, González A, Mugüerza J M, Ratia T
Service of General Surgery, Príncipe de Asturias University Hospital, Alcalá de Henares, Madrid, Spain.
Rev Esp Enferm Dig. 1998 Aug;90(8):563-72.
To assess the clinical and biological significance of histological typing of colorectal carcinomas.
The retrospective analysis of 142 consecutive patients who underwent surgical resection of a mucinous (MC; n = 27; 19%) or a nonmucinous (nMC; n = 115; 81%) colorectal adenocarcinoma was carried out. The two groups were compared in terms of the clinical features, p53 gene expression (antiserum CM1), proliferating cell nuclear antigen (PCNA) labeling index, DNA ploidy (by flow cytometry), histopathological features, prognosis and recurrence rate.
The two types of tumors differed with respect to patient age, location, morphology, pattern of genetic lesions and type of tumor recurrences. Twenty-five percent of the patients with MC and 9% of those with nMC (p = 0.04) were under 50 years of age. The incidences of right MC and left MC were similar, while the majority of the nMC were located on the left side (p = 0.04). The MC were of higher grade and their margins more infiltrative than those of the nMC (p = 0.001 and p = 0.01, respectively), p53 nuclear staining was observed less frequently in the MC than in the nMC (30% vs 55%; p = 0.03). The PCNA labeling index was higher in the nMC (46% vs 21%; p = 0.05). We observed no significant differences with respect to tumor stage, incidence of vascular invasion or prevalence of lymphocytic infiltration. The prognosis was similar in both groups, although their recurrence patterns differed, with a tendency toward locoregional recurrence in the cases of MC.
These findings suggest that, despite their similar prognoses, these two types of lesions are epidemiologically, phenotypically and genotypically different and, thus, result from distinct carcinogenic pathways.
评估结直肠癌组织学类型的临床及生物学意义。
对142例连续接受黏液性（MC；n = 27；19%）或非黏液性（nMC；n = 115；81%）结直肠腺癌手术切除的患者进行回顾性分析。比较两组患者的临床特征、p53基因表达（抗血清CM1）、增殖细胞核抗原（PCNA）标记指数、DNA倍体（通过流式细胞术）、组织病理学特征、预后及复发率。
两种类型的肿瘤在患者年龄、部位、形态、基因病变模式及肿瘤复发类型方面存在差异。25%的MC患者和9%的nMC患者年龄小于50岁（p = 0.04）。右半MC和左半MC的发生率相似，而大多数nMC位于左侧（p = 0.04）。MC的分级更高，边缘浸润性比nMC更强（分别为p = 0.001和p = 0.01），MC中p53核染色的观察频率低于nMC（30%对55%；p = 0.03）。nMC的PCNA标记指数更高（46%对21%；p = 0.05）。在肿瘤分期、血管侵犯发生率或淋巴细胞浸润患病率方面未观察到显著差异。两组的预后相似，尽管复发模式不同，MC病例有局部区域复发的倾向。
这些发现表明，尽管这两种类型的病变预后相似，但在流行病学、表型和基因型上存在差异，因此是由不同的致癌途径导致的。
