病理组织学生长方式对肝转移性结直肠癌患者术后3年无进展生存期的预测作用

Value of histopathological growth pattern in predicting 3-year progression free survival after operation in patients with liver metastasis of colorectal cancer

目的探讨病理组织学生长方式对肝转移性结直肠癌患者肝转移瘤切除术后3年无进展生存期(PFS)的预测作用。方法收集2007年1月至2017年1月间北京大学人民医院收治的经病理确诊并进行手术完整切除的肝转移性结直肠癌患者111例的临床病理资料,排除不符合入组标准的病例,最后入组患者共80例。根据组织学生长方式国际专家共识标准,评估其肝转移瘤的组织学生长方式类型。通过χ^(2)或Fisher确切检验分析组织学生长方式与其他临床病理因素的相关性。通过Kaplan-Meier生存曲线分析不同组织学生长方式的肝转移性结直肠癌患者3年PFS的差异,并通过单因素及多因素分析,确定影响其3年PFS的独立危险因素。结果共入组80例患者,其中促纤维组织增生型43例(54%)、替代型32例(40%)、推挤型3例(4%)、混合型2例(2%)。组织学生长方式与患者年龄、性别、转移瘤发生时间、肿瘤负荷、组织学分级、是否伴有黏液分化及微卫星不稳定性等临床病理特征无相关性(P>0.05)。促纤维组织增生型患者的3年PFS明显优于替代型患者,差异有统计学意义(χ^(2)=6.107,P=0.013)。单因素及多因素分析均显示组织学生长方式为预后的独立影响因素。结论结直肠癌肝转移瘤组织学生长方式主要表现为促纤维组织增生型和替代型。组织学生长方式为肝转移性结直肠癌患者术后独立的预后因素,故组织学生长方式需要在病理报告中明确指出,以提示临床合理选择治疗策略。

Objectives To investigate the value of histopathological growth patterns(HGP)in predicting the 3-year progression free survival(PFS)after resection the liver metastasis from patients with colorectal cancer.Methods The clinicopathological data of the 111 patients with liver metastasis of colorectal cancer diagnosed at Peking University People′s Hospital,Beijing,China from January 2007 to January 2017 were analyzed.After excluding the patients who did not meet the inclusion criteria,a total of 80 patients were analyzed.According to the international expert consensus on HGP,the HGP types of liver metastasis were evaluated.The correlation between HGP and other clinicopathological factors was analyzed using χ^(2) or Fisher test.Kaplan-Meier survival curve was used to examine 3-year PFS in the patients with liver metastasis of colorectal cancer by HGP.The independent risk factors of 3-year post-resection PFS were determined using univariable and multivariable analyses.Results A total of 80 cases were analyzed,including 43 cases of desmoplastic type(54%),32 cases of replacement type(40%),3 cases of pushing type(4%),and 2 cases of mixed type(2%).There was no correlation of HGP with age,gender,time of metastasis,tumor burden,histological grade,mucous differentiation or microsatellite instability.The 3-year post-resection PFS of the patients with desmoplastic type was significantly longer than that of patients with replacement type.The univariable and multivariable analyses showed that HGP was an independent prognostic factor.Conclusions The HGP of colorectal cancer metastases to the liver mainly present as desmoplastic and replacement types.HGP is an independent prognostic factor for the patients with liver metastasis of colorectal cancer after resection of the metastasis.Therefore,HGP should be clearly indicated in the pathological report to help guide clinical treatments.