直肠癌远侧肠壁癌细胞的浸润及p53的表达

p53 expression and cancer cell invasion in the distal bowel wall of patients with rectal carcinoma

目的运用组织病理学和分子病理学的方法探讨直肠癌安全远侧切缘的合适长度。方法采用常规病理切片HE染色和免疫组织化学SABC法观察68例直肠癌远侧肠壁中癌细胞的浸润规律及p53的表达范围。结果52.9%(36/68)直肠癌远侧肠壁存在癌细胞浸润,其中88.9%(32/36)的患者浸润距离≤2cm,均未超出3cm,并与原发癌的大体类型、组织学类型、Dukes分期相关;23.5%(16/68)直肠癌远侧癌旁组织存在p53的表达,其中81.3(13/16例)的患者p53的表达范围≤2cm,均未超出3cm,并与原发癌的临床病理学特征不相关。结论3cm可作为直肠癌的安全远侧切缘。

Objective To determine an adequate distal bowel length to be excised for safe surgical removal of rectal carcino-ma. Methods p53 expression and patterns of cancer cell invasion into the bowel wall distal to the tumors were studied in 68 surgically removed rectal carcinoma specimens with immunohistochemical and routine pathological methods respectively. Results In 52.9% (36/68) of the cases, cancer cell infiltration in the bowel was found microscopically, among which 32 (88.9%) had the infiltration confined within 2 cm from the primary tumors, with the rest cases within 3 cm. The scope of the distal infiltration of the cancer cells was correlated to the gross morphology, histological type and Dukes' stages of the primary tumors. Of the 16 cases (23.5% ) positive for p53 expression in the distal bowel mucosa, 13 had p53 expression profile detect-ed within 2 cm, all within 3 cm. The expression of p53 in the distal bowel mucosa was not correlated with the clinical and pathological features of the primary rectal carcinoma. Conclusion Excision till the compromised bowel 3 cm distal to the tu-mor may ensure safe removal of rectal cancer.