一种新的结直肠癌组织学分型、分级-评分方案

A novel histological typing and grading-scale system of colorectal cancer

目的：提出一种新型结直肠癌组织学分型、分级-评分方案，为结直肠癌的生物学行为和预后判断提供评估指标。方法根据结直肠癌高度异质性的组织学特征、参照WHO分型方案和目前对结直肠癌组织学分型、分化程度与生物学行为相关性的研究成果，设计新型结直肠癌组织学分型、分级-评分方案：（1）将结直肠癌分为不同组织学类型并予以评分：④非黏液性腺癌（管状腺癌、筛状粉刺型腺癌、髓样癌、锯齿状腺癌、微乳头状癌等，1~3分）；④黏液性腺癌（黏液腺癌、印戒细胞癌，评3~4分）；④鳞癌（1~3分）；④神经内分泌肿瘤（神经内分泌瘤、神经内分泌癌，1~4分）；④特殊类型结直肠癌（透明细胞癌、梭形细胞癌等，4分）；④未分化癌（5分）；（2）病理诊断书写格式：按照组织学结构主次顺序诊断，如＊＊＊癌伴＊＊＊癌；（3）计分方法：将结直肠癌组织中的不同组织类型的分级-评分累计作为结直肠癌的总评分，单一结构组成的结直肠癌其分值乘以2获得最终得分。并采用这一方案对666例进展期结直肠癌患者病理标本进行组织学分型、分级-评分，分析其与TNM分期和淋巴结癌转移之间的相关性。结果结直肠癌组织学分级-评分与结直肠癌的TNM分期和是否伴有淋巴结癌转移关系密切，结直肠癌组织学分级-评分随着结直肠癌的TNM分期和淋巴结癌转移而升高，并具显著统计学意义（P＆lt;0.05）。结论该分级-评分方案能够客观评价结直肠癌的生物学行为和侵袭转移能力，有可能成为一个评价结直肠癌生物学行为及预后预测的具有重要价值的新客观指标，但仍有必要经过前瞻性多中心、大规模临床研究对该新型结直肠癌组织学分型、分级-评分方案进行持续修订和更新。

Objective To formulate a novel histological typing and grading-rated system for colorectal cancer （CRC） for evaluating the biological behavior of CRC and prognosis. Methods According to the highly heterogeneous histological features, WHO classification and histological differentiation criteria, and other biological behavior parameters of CRC, a novel histological typing and grading-scale system for CRC was designed. The histological typing and corresponding grading-scale of CRC was defined as the following：（1） No mucin-producing adenocarcinoma, including tubular adenocarcinoma, sieve-like acne adenocarcinoma, medullary carcinoma, serrated adenocarcinoma and micropapillary carcinoma, etc. （1-3 points）; （2） Mucin-producing adenocarcinoma, including mucinous adenocarcinoma and signet ring cell carcinoma （3-4 points）; （3） Squamous cell carcinoma （1- 3 points）; （4） Neuroendocrine tumors, including neuroendocrine tumors, neuroendocrine carcinoma （1-4 points）;（5） The special type of CRC, including clear cell carcinoma, spindle cell carcinoma, etc. （4-points）;（6） Undifferentiated carcinoma （5 points）. The pathology report form was formated based on the major histological type with the secondary histological type. The final total score of CRC was defined as the sum of the corresponding grading scores for different histological types. The total score of a single-structure CRC was defined as the corresponding grading score multiplied by 2. A total of 666 patients with advanced CRC were pathologically reviewed and analyzed to assess the correlation of the histological typing and grading scores with TNM staging and lymph node metastasis. Results The results showed a significant correlation of the histological grading-scale and TNM staging and lymph node metastasis （P＆lt;0.05）. The scores of CRC histological grading-scale increased synchronously with the TNM staging and lymph node metastasis rate. Conclusion The novel histological grading system allows objective evaluation of the biological behaviors and prognosis of CRC for determining individualized postoperative treatment. This system still needs further revision and updates based on evidence from prospective, multi-centered, large-scale trials.