差分化细胞群分级系统在结直肠腺癌中的应用价值研究

    The Value of Poorly Differentiated Clusters Grading System in Colorectal Adenocarcinoma

    • 摘要: 背景与目的 基于传统肿瘤分化程度的组织学分级(tumor differentiation grade,TDG)系统应用广泛,但存在预后价值不足、构成比分布不均等局限性。基于量化差分化细胞群(poorly differentiated cluster,PDC)的新分级系统具有可重复性和提高预后价值的优势。本研究旨在探讨PDC分级与结直肠腺癌临床病理参数之间的关系,分析新型组织学分级系统在临床应用中的价值。 方法 回顾性收集2015年1月至2015年12月,在广东省中医院行根治性手术切除的结直肠腺癌标本445例,其中男性237例,女性208例,年龄31~93岁,中位年龄64岁,肿瘤最大直径0.9~9.0 cm,平均最大直径4.7 cm,左半结肠癌155例,右半结肠癌112例,直肠癌178例。按照标准的评估方法对PDC进行计数并分成三级,分析结直肠腺癌各项病理学参数与不同级别PDC之间的关系;按照世界卫生组织(World Health Organization,WHO)的方法将TDG分成二类,比较PDC与TDG两个系统的分布差异,并使用改良的PDC系统(二级)对TDG构成比较大的部分进行再分层分析。 结果 445例结直肠腺癌,按PDC分级系统,PDC1级为122例(27.4%),PDC2级为126例(28.3%),PDC3级为197例(44.3%),PDC分级与肿瘤浸润深度、淋巴管血管侵犯、淋巴结转移、神经侵犯、远处转移及肿瘤出芽呈正相关(P<0.05),而与患者性别、年龄、肿瘤部位及肿瘤大小无关(P>0.05)。按TDG分级系统,低级别TDG(TDG low,TDG-L)和高级别TDG(TDG high,TDG-H)的病例分别为365例(82.0%,构成比明显偏大),80例(18.0%),PDC的构成比分布较TDG平均。使用改良的PDC分级系统对365例TDG-L进行再分层,改良的PDC分级与TDG-L组中的肿瘤浸润深度、淋巴管血管侵犯、淋巴结转移、神经侵犯及肿瘤出芽呈正相关(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,基于PDC分级系统对结直肠腺癌进行新的组织学分级是可行的,将为患者提供更多的有价值的预后信息,还可使用PDC将TDG-L进行再分层,PDC分级系统可能是比传统组织学分化程度更客观和实用的预后分类参数。

       

      Abstract: Background and purpose The tumor differentiation grade (TDG) system based on the traditional degree of differentiation was widely used. However, it had limitations such as insufficient prognostic value and uneven distribution of constituent ratios. A new grading system based on quantifying poorly differentiated clusters (PDCs) had the advantages of reproducibility and improved prognostic value. This study aimed to investigate the relationship between PDC grading and clinicopathological parameters of colorectal adenocarcinoma and to analyze the value of a new histological grading system in clinical application. Methods 445 patients with colorectal adenocarcinoma who underwent radical surgical resection from January 2015 to December 2015 at Guangdong Provincial Hospital of Chinese Medicine were retrospectively collected, including 237 males and 208 females, ranging in age from 31 to 93 years, with a median age of 64. Tumor size ranged from 0.9 to 9.0 cm (mean 4.7 cm). There were 155 cases of left colon cancer, 112 cases of right colon cancer, and 178 cases of rectal cancer. According to the standard evaluation method, PDC was divided into three grades, and the relationship between PDC grade and other clinicopathological parameters of colorectal adenocarcinoma was analyzed. According to the World Health Organization (WHO), TDG was divided into two grades. The distribution differences between the PDC and TDG systems were analyzed, and the improved PDC system (two grades) was re-graded to a significant part of TDG. Results Among 445 cases of colorectal adenocarcinoma, 122 cases (27.4%) were G1 grade, 126 cases (28.3%) were G2 grade, and 197 cases (44.3%) were G3 grade. PDC was positively correlated with invasion depth, lymphovascular invasion, lymph node metastasis, nerve invasion, distant metastasis stage, and tumor budding (TB)(P<0.05), but not with gender, age, tumor site, and tumor size (P>0.05). According to the TDG grading system, 365 cases (82.0%, the proportion was obviously high) were TDG low (TDG-L), and 80 cases (18.0%) were TDG high (TDG-H). The distribution of the PDC was more even than TDG. 365 cases of TDG-L were re-graded using the modified PDC grading system. The PDC grading was positively correlated with the depth of tumor invasion, lymphovascular invasion, lymph node metastasis, nerve invasion, and tumor budding in the TDG-L group (P<0.05). Conclusions PDC was closely related to the invasive biological behavior of colorectal adenocarcinoma. Classifying colorectal adenocarcinoma with a new histological grade based on the PDC grading system was feasible, which might provide patients with more valuable prognostic information. TDG-L could be re-graded using PDC, which might be a more objective and practical prognostic classification parameter than traditional histological differentiation.

       

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