CAJ | 학술논문

目的探讨肿瘤浸润肥大细胞(TIM)在结直肠癌患者中的预后价值.方法收集2002年1月至2005年12月中山大学附属第一医院收治的282例行首次根治性切除的结直肠癌患者的肿瘤石蜡标本,通过免疫组织化学染色计算TIM的密度,根据TIM的平均密度[(8.4±6.5)／高倍视野],将患者分为TIM少量浸润组(TIM平均密度＜8.4/高倍视野)和TIM大量浸润组(TIM平均密度≥8.4／高倍视野),比较两组患者的临床病理因素及其预后情况.计量资料采用t检验,计数资料采用x2检验.采用KaplanMeier法绘制生存曲线,Log-rank检验分析患者生存情况.影响结直肠癌患者生存时间的单因素及多因素分析采用COX比例风险模型.结果 TIM在结直肠癌患者中均有不同程度的浸润.TIM少量浸润组和TIM大量浸润组患者在结直肠癌的N分期和TNM分期方面比较,差异有统计学意义(x2=6.025,7.410,P＜0.05).随访截至2010年9月,TIM少量浸润组、TIM大量浸润组患者的5年总生存率和无瘤生存率分别为82.9％、79.0％和63.1％、59.3％,两组比较,差异均有统计学意义(P＜0.05).COX比例风险模型单因素分析结果显示,肥大细胞在肿瘤组织中的浸润是影响结直肠癌患者总生存时间和无瘤生存时间的不良因素(RR=2.119,95％可信区间1.326～3.386;RR =2.084,95％可信区间1.357～3.199,P ＜0.05).多因素分析结果显示TIM是结直肠癌患者总生存时间和无瘤生存时间的独立影响因素(RR=1.651,95％可信区间1.009～2.702;RR=1.680,95％可信区间1.047～2.629,P＜0.05).结论 TIM与结直肠癌的N分期和TNM分期相关,并且TIM是结直肠癌患者预后不良的独立影响因素.
목적 탐토종류침윤비대세포(TIM)재결직장암환자중적예후개치.방법 수집2002년1월지2005년12월중산대학부속제일의원수치적282례행수차근치성절제적결직장암환자적종류석사표본,통과면역조직화학염색계산TIM적밀도,근거TIM적평균밀도[(8.4±6.5)／고배시야],장환자분위TIM소량침윤조(TIM평균밀도＜8.4/고배시야)화TIM대량침윤조(TIM평균밀도≥8.4／고배시야),비교량조환자적림상병리인소급기예후정황.계량자료채용t검험,계수자료채용x2검험.채용KaplanMeier법회제생존곡선,Log-rank검험분석환자생존정황.영향결직장암환자생존시간적단인소급다인소분석채용COX비례풍험모형.결과 TIM재결직장암환자중균유불동정도적침윤.TIM소량침윤조화TIM대량침윤조환자재결직장암적N분기화TNM분기방면비교,차이유통계학의의(x2=6.025,7.410,P＜0.05).수방절지2010년9월,TIM소량침윤조、TIM대량침윤조환자적5년총생존솔화무류생존솔분별위82.9％、79.0％화63.1％、59.3％,량조비교,차이균유통계학의의(P＜0.05).COX비례풍험모형단인소분석결과현시,비대세포재종류조직중적침윤시영향결직장암환자총생존시간화무류생존시간적불량인소(RR=2.119,95％가신구간1.326～3.386;RR =2.084,95％가신구간1.357～3.199,P ＜0.05).다인소분석결과현시TIM시결직장암환자총생존시간화무류생존시간적독립영향인소(RR=1.651,95％가신구간1.009～2.702;RR=1.680,95％가신구간1.047～2.629,P＜0.05).결론 TIM여결직장암적N분기화TNM분기상관,병차TIM시결직장암환자예후불량적독립영향인소.
Objective To investigate the relationship between tumor-infiltrating mast cell (TIM) and the clinicopathological and prognostic factors of patients with colorectal cancer.Methods A total of 282 cases of paraffin-embedded colorectal cancer specimens were obtained from the First Affiliated Hospital of Sun Yat-sen University from January 2002 to December 2005.The density of TIM was determined by immunohistochemical staining.According to the mean TIM density detected [ ( 8.4 + 6.5 )/HPF ],all the patients were divided into low-TIM density group (mean TIM density ＜8.4/HPF) and high-TIM density group (mean TIM density ＞8.4/HPF).The clinicopathological factors and the prognosis of patients between high-TIM density group and low-TIM density group were compared.All data were analyzed using the t test or chi-square test.The survival curve was drawn using the Kaplan-Meier method,and the survival of the patients was analyzed by the Log-rank test.The clinicopathological factors were analyzed retrospectively with the univariate and multivariate COX regression model.Results TIM was detected in all the patients with colorectal cancer.Significant differences were observed in the number of patients in N stage and TNM stage between patients in the high-TIM density group and those in the lowTIM density group (x2 =6.025,7.410,P ＜ 0.05 ).All patients were followed up till September 2010,the 5-year overall and tumor-free survival rates of patients were 82.9％ and 63.1％ in the low-TIM density group,79.0％ and 59.3％ in the high-TIM density group,with significant difference between the 2 groups (P ＜ 0.05 ).COX proportional hazard regression model revealed that high density of TIM was associated with short overall survival time and tumor-free survival time of colorectal cancer patients ( RR =2.119,95 ％ CI 1.326- 3.386; RR =2.084,95 ％ CI 1.357-3.199,P ＜0.05).The resuhs of multivariate analysis showed that high density of TIM was the independent factor influencing the overall survival time and tumor-free survival time (RR =1.651,95％ CI 1.009-2.702; RR =1.680,95％ CI 1.074-2.629,P ＜ 0.05 ).Conclusion High density of TIM is correlated with the N stage and TNM stage of colorectal cancer,and it is an independent predictor of poor survival for patients with colorectal cancer.