肿瘤芽孢与T2期直肠癌患者临床病理特征及预后的关系

Association of tumor budding with clinicopathological characteristics and prognosis in T2 rectal cancer

目的探讨肿瘤芽孢与T2期直肠癌患者临床病理特征及预后的关系。方法收集2001—2005年间在上海长海医院接受根治性手术的123例B期直肠癌患者的临床病理资料，将其直肠癌标本进行切片，行苏木精-伊红染色，通过镜下肿瘤芽孢计数获得芽孢最大值及其平均值。将芽孢最大值及其平均值均分为l级（芽孢数小于或等于5）、2级（芽孢数介于5和10之间）和3级（芽孢数大于或等于10）。结果单因素和多因素分析结果显示，芽孢最大值和平均值及淋巴管浸润是淋巴结转移的独立影响因素（P〈0．01）。芽孢最大值与肿瘤分化程度和神经浸润有关（P〈0.05和P〈0.01）：芽孢平均值与肿瘤分化程度、血管浸润及神经浸润有关（均P〈0．01）。芽孢平均值1级、2级和3级患者的平均无瘤生存期分别为110．5、95．8和60．0个月，1级与2、3级比较，差异有统计学意义（P〈0．05）：而2、3级间比较差异无统计学意义（P〉0．05）。芽孢最大值1级、2级和3级患者的平均无瘤生存期分别为115．1、98．5和86．0个月，1级与3级和2级与3级比较，差异均有统计学意义（火0．01和P〈0.05）；而1级与2级比较，差异无统计学意义（均P〉0.05）。结论肿瘤芽孢是评估直肠癌侵袭力的一个较好的指标，对评估预后也有较高的价值。

Objective To demonstrate the association of tumor budding with clinicopathological features and prognosis in T2 rectal cancer. Methods Clinicopathological data of 123 patients who underwent potentially curative resection for T2 rectal carcinoma between 2001 and 2005 at the Changhai Hospital were collected. All pathology slides were stained with hematoxlin and eosin for microscopic examinations. The maximum value of tumor buds （MV） and average value of tumor buds （AV） were calculated, which were classified as low value （≤5）, median value（5〈bud value〈10）, and high value （≥ 10）. Results Univariate analysis and multivariate analysis revealed that MV （P=0.000）, AV （P= 0.001 ）, and lymphatic invasion （P=0.006） were independent predictors for lymph node metastasis in T2 rectal cancer. Neural invasion and poorly differentiation were significantly associated with MV （P〈0.05）. Neural invasion, vascular invasion and poorly differentiationwere were significantly associated to AV（P〈 0.01）. Disease-free survival （DFS） of patients with low AV, median AV and high AV was 110.5 months, 95.8 months, and 60.0 months respectively. There were significance differences in DFS of low AV with median and high AV （P〈0.05）. DFS of patients with low MV, median MV and high MV was 115.1 months, 98.5 months, and 86.0 months respectively. There were significance differences in DFS between low and high AV, and median and high MV （P〈0.01 and P〈0.05）, while no significant difference existed between low and median MV. Conclusion Tumor budding is a useful marker to indicate high invasiveness of rectal cancer and a valuable prognostic predictor.