Ⅱ期结肠癌患者肿瘤芽胞检测的临床意义

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（-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。

Clinical significance of tumor budding detection in stage II colon cancer

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%Cl：2.218-11.746, P=0.002）and cancer-related death （RR=4.116, 95%CI：1.657-10.384, P=0.O12）. 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