中华胃肠外科杂志
中華胃腸外科雜誌
중화위장외과잡지
CHINESE JOURNAL OF GASTROINTESTINAL SURGERY
2013年
8期
730-734
,共5页
刘少杰%杨小红%任镜清%朱宣进
劉少傑%楊小紅%任鏡清%硃宣進
류소걸%양소홍%임경청%주선진
结肠肿瘤,Ⅱ期%肿瘤芽胞%预后%复发风险
結腸腫瘤,Ⅱ期%腫瘤芽胞%預後%複髮風險
결장종류,Ⅱ기%종류아포%예후%복발풍험
Colonic neoplasms,stage Ⅱ%Tumor budding%Prognosis%Recurrence risk
目的 探讨肿瘤芽胞与Ⅱ期结肠癌患者术后复发及生存的关系,从而为高危复发患者的筛选及其临床决策提供参考.方法 回顾性分析1998-2007年间广州红十字会医院收治的112例Ⅱ期结肠癌患者的临床资料.由两名观察者分别独立选取苏木精-伊红染色切片下肿瘤芽胞最密集的视野进行肿瘤芽胞计数,将112例患者分为高级别组(芽胞数目大于或等于10,30例)和低级别组(芽胞数目小于或等于9,82例).比较两组患者术后无复发生存率及肿瘤相关生存率,并对两名观察者胞瘤芽胞检测结果的一致性进行评价.结果 所有患者均获随访,中位随访时间78(11～121)月.高级别组和低级别组患者5年无进展生存率分别为65.3％和90.7％,5年肿瘤相关生存率分别为72.1％和93.8％,差异均有统计学意义(P=0.008和P=0.001).多因素预后分析结果证实,肿瘤芽胞是影响本组Ⅱ期结肠癌患者术后无进展生存(RR=4.572,95％CI:2.218～11.746,P=0.002)和肿瘤相关生存(RR=4.116,95％CI:1.657～10.384,P=0.012)的独立预后因素.两名观察者对98例(87.5％)患者取得了相同的肿瘤芽胞评估结果,一致性较好(Kappa=0.688).结论 肿瘤芽胞是一项高效且可重复的Ⅱ期结肠癌不良预后指标,可用以需术后辅助治疗的高危复发患者的筛选.
目的 探討腫瘤芽胞與Ⅱ期結腸癌患者術後複髮及生存的關繫,從而為高危複髮患者的篩選及其臨床決策提供參攷.方法 迴顧性分析1998-2007年間廣州紅十字會醫院收治的112例Ⅱ期結腸癌患者的臨床資料.由兩名觀察者分彆獨立選取囌木精-伊紅染色切片下腫瘤芽胞最密集的視野進行腫瘤芽胞計數,將112例患者分為高級彆組(芽胞數目大于或等于10,30例)和低級彆組(芽胞數目小于或等于9,82例).比較兩組患者術後無複髮生存率及腫瘤相關生存率,併對兩名觀察者胞瘤芽胞檢測結果的一緻性進行評價.結果 所有患者均穫隨訪,中位隨訪時間78(11～121)月.高級彆組和低級彆組患者5年無進展生存率分彆為65.3％和90.7％,5年腫瘤相關生存率分彆為72.1％和93.8％,差異均有統計學意義(P=0.008和P=0.001).多因素預後分析結果證實,腫瘤芽胞是影響本組Ⅱ期結腸癌患者術後無進展生存(RR=4.572,95％CI:2.218～11.746,P=0.002)和腫瘤相關生存(RR=4.116,95％CI:1.657～10.384,P=0.012)的獨立預後因素.兩名觀察者對98例(87.5％)患者取得瞭相同的腫瘤芽胞評估結果,一緻性較好(Kappa=0.688).結論 腫瘤芽胞是一項高效且可重複的Ⅱ期結腸癌不良預後指標,可用以需術後輔助治療的高危複髮患者的篩選.
목적 탐토종류아포여Ⅱ기결장암환자술후복발급생존적관계,종이위고위복발환자적사선급기림상결책제공삼고.방법 회고성분석1998-2007년간엄주홍십자회의원수치적112례Ⅱ기결장암환자적림상자료.유량명관찰자분별독립선취소목정-이홍염색절편하종류아포최밀집적시야진행종류아포계수,장112례환자분위고급별조(아포수목대우혹등우10,30례)화저급별조(아포수목소우혹등우9,82례).비교량조환자술후무복발생존솔급종류상관생존솔,병대량명관찰자포류아포검측결과적일치성진행평개.결과 소유환자균획수방,중위수방시간78(11～121)월.고급별조화저급별조환자5년무진전생존솔분별위65.3％화90.7％,5년종류상관생존솔분별위72.1％화93.8％,차이균유통계학의의(P=0.008화P=0.001).다인소예후분석결과증실,종류아포시영향본조Ⅱ기결장암환자술후무진전생존(RR=4.572,95％CI:2.218～11.746,P=0.002)화종류상관생존(RR=4.116,95％CI:1.657～10.384,P=0.012)적독립예후인소.량명관찰자대98례(87.5％)환자취득료상동적종류아포평고결과,일치성교호(Kappa=0.688).결론 종류아포시일항고효차가중복적Ⅱ기결장암불량예후지표,가용이수술후보조치료적고위복발환자적사선.
Objective To investigate the association of tumor budding with recurrence and survival of patients with stage Ⅱ colon cancer,in order to indentify patients with high-risk recurrence who may benefit from adjuvant therapy.Methods Clinical data of 112 stage Ⅱ colon cancer patients in Guangzhou Red Cross Hospital between 1998 and 2007 were analyzed retrospectively.The degree of tumor budding was assessed by two observers and classified according to the number of tumor buds in the area with the greatest budding intensity on HE stain slides,as high-grade budding (≥ 10,n=30) and low-grade budding (≤9,n=82).Progression-free and cancer-specific survival were analyzed using the Kaplan-Meier method and Cox regression.Inter-observer agreement for two observers was assessed by kappa statistic test.Results All the patients were followed up and the median follow-up was 78 months.The 5-year progression-free survival rates for patients with high-grade and low-grade budding were 65.3％ and 90.7％ respectively(P=0.008).The 5-year cancer-specific survival rates were 72.1％ and 93.8％ respectively (P=0.001).Cox regression analysis demonstrated tumor budding was an independent predictor of disease progression(RR=4.572,95％CI:2.218-11.746,P=0.002) and cancer-related death (RR=4.116,95％CI:1.657-10.384,P=0.012).Two observers agreed on the classification of tumor budding in 98 cases (87.5％) and the inter-observer agreement was good (Kappa=0.688).Conclusion Tumor budding is a strong and reproducible prognostic index for adverse outcome in stage Ⅱ colon cancer patients,which may serve as a prognostic marker to identify patients with high risk of recurrence who may benefit from adjuvant therapy.
