神经脉管浸润联合肿瘤间质比对结直肠癌预后的预测价值

Value of combined perineural lymphovascular invasion and tumor-stroma ratio in guiding the prognosis of colorecatal cancer

目的·探讨肿瘤间质比(tumor-stroma ratio,TSR)、神经浸润(perineural invasion,PNI)、脉管浸润(lymphovascular invasion,LVI)对结直肠癌(colorectal cancer,CRC)患者预后的预测价值。方法·回顾性分析2014年1月—2018年12月在上海交通大学医学院附属第一人民医院确诊为CRC的948例患者资料,按病理高危因素TSR、PNI、LVI分为高风险组(n=81)和低风险组(n=867),经SPSS软件进行1∶1病例匹配后得到高风险组67例。低风险组67例,比较高风险组患者和低风险组患者的总生存时间(overall survival,OS),并使用该课题组106例结直肠癌组织芯片(tissue microarray,TMA)数据进行验证。比较高风险组和低风险组的临床特点,采用Kaplan-Meier法进行生存分析,COX回归模型分析影响预后的因素。结果·与低风险组患者中位OS(31.1个月)相比,高风险组患者中位OS(27.7个月)缩短,预后更差(P=0.000)。经过配对后发现具有神经脉管浸润阳性联合高肿瘤间质比特征对预测CRC预后的价值更大,并且在TMA数据中也得到了验证。结论·神经脉管浸润阳性联合高TSR的CRC是一类预后不良的CRC,可以弥补肿瘤-淋巴结-转移(tumor-node-metastasis,TNM)病理分期系统对预后预测的缺陷,可以用于预估CRC患者术后病情发展及指导治疗。

Objective·To explore the prognosis effects of tumor-stroma ratio(TSR),perineural invasion(PNI)and lymphovascular invasion(LVI)on patients with colorectal cancer(CRC).Methods·Data of 948 patients diagnosed with CRC in Shanghai General Hospital,Shanghai Jiao Tong University School of Medicine from January 2014 to December 2018 were retrospectively analyzed,and according to pathological risk factors TSR,PNI and LVI,patients were divided into high risk group(n=81)and low risk group(n=867).After 1∶1 matching with SPSS software,67 patients of the high risk group and 67 patients of the low risk group were obtained.The overall survival(OS)time was compared between patients in the high risk group and low risk group.The results were validated by using tissue microarray(TMA)dataset of 106 CRC patients from our research group.The clinical characteristics of the high risk group and low risk group were compared.Kaplan-Meier curve was used for survival analysis,and COX regression model was used to analyze the prognosis factors.Results·Patients in the high risk group had a worse prognosis with a short median OS(27.7 months)than patients in the low risk group(31.1 months,P=0.000).The worse OS in patients with high risk group was validated in matched data and TMA dataset.Conclusion·CRC with positive perineural lymphovascular invasion combined with high TSR is a type of CRC with poor prognosis,which can effectively make up for the defect of tumor-node-metastasis(TNM)stage in prognosis and can be used to predict postoperative disease development of CRC patients and guide treatment.