结直肠腺癌差分化细胞群与临床病理学参数的相关性研究

A study of correlation between poorly differentiated clusters and clinicopathological parameters in colorectal adenocarcinoma

背景与目的:基于分化程度的组织学分级在结直肠癌生物学行为的评估上存在局限性,寻找更多的形态学指标将为结直肠癌患者的预后和分层管理提供更多依据。探讨结直肠腺癌差分化细胞群(poorly differentiated clusters,PDC)与临床病理学参数之间的关系及其意义。方法:收集2019年1月—2020年10月在广东省中医院珠海医院行根治性手术切除的结直肠腺癌标本101例。其中男性54例,女性47例,年龄29~86岁,中位年龄62岁,肿瘤大小1.5~9.0 cm,平均4.5 cm,左半结肠癌42例,右半结肠癌21例,直肠癌38例。在光镜下观察H-E切片中结直肠腺癌PDC数量并进行分级,分析PDC分级与结直肠腺癌其他临床病理学参数之间的关系。结果:101例结直肠腺癌患者中,PDC分级G1级为42例(41.6%),G2级为29例(28.7%),G3级为30例(29.7%)。结直肠腺癌中PDC与组织学分级、浸润深度、淋巴结转移、淋巴管血管侵犯、神经侵犯、远处转移分期及肿瘤芽(tumor budding,TB)呈正相关(P<0.05),而与患者年龄、性别、肿瘤部位、肿瘤大小无关(P>0.05)。结论:PDC与结直肠腺癌侵袭性的生物学行为密切相关。PDC有可能是继TB之后的另一个比传统组织学分级更为有效的预后指标。识别和评估结直肠腺癌中PDC分级可以更好地预测结直肠腺癌的生物学行为,从而更加准确地指导结直肠癌患者的治疗和预后评估。

Background and purpose:Histological grading based on the degree of differentiation has limitations in evaluating the biological behavior of colorectal cancer.Finding more morphological indicators will provide more evidence for the prognosis and stratified management of colorectal cancer.This study aimed to investigate the relationship between poorly differentiated clusters(PDC)and clinicopathological parameters in colorectal adenocarcinoma and its significance.Methods:Data of 101 patients with colorectal adenocarcinoma who underwent radical surgical resection in Zhuhai Hospital of Guangdong Provincial Hospital of Traditional Chinese Medicine from January 2019 to October 2020 were collected.Among them,there were 54 males and 47 females,ranging in age from 29 to 86 years with median age of 62 years.Tumor size ranged from 1.5 to 9.0 cm(mean 4.5 cm).There were 42 cases of left colon cancer,21 cases of right colon cancer and 38 cases of rectal cancer.The number of PDC of colorectal adenocarcinoma in H-E section was observed under light microscope and graded,and the relationship between PDC grade and other clinicopathological parameters of colorectal adenocarcinoma was analyzed.Results:Among 101 cases of colorectal adenocarcinoma,42 cases(41.6%)were G1 grade,29 cases(28.7%)were G2 grade,and 30 cases(29.7%)were G3 grade.In colorectal adenocarcinoma,PDC was positively correlated with histological grade,invasion depth,lymph node metastasis,lymphovascular invasion,nerve invasion,distant metastasis stage and tumor budding(TB)(P<0.05),but not with patient age,gender,tumor site or tumor size(P>0.05).Conclusion:PDC is closely related to the invasive biological behavior of colorectal adenocarcinoma.PDC is likely to be a more effective prognostic marker than traditional histological grading after TB.Identification and evaluation of PDC grading in colorectal adenocarcinoma can better predict the biological behavior of colorectal adenocarcinoma,and thus more accurately guide the treatment and prognosis evaluation of colorectal cancer.