一项简单易行的预测Dukes C期大肠癌切除术后肝转移的生物学指标

目的:本研究旨在探讨瘤芽在不同大肠癌病例的分布特征以及骨桥蛋白(OPN)等在原发癌灶和瘤芽的表达,以评价其可否作为简单易行的预测大肠癌术后肝转移的生物学指标。方法:将Dukes C期以上病例分成3组:A组为同时性肝转移组,B组为异时性肝转移组,C组为无肝转移组。HE染色后,重点观察位于大肠癌侵袭前沿的瘤芽的分布特征,并准确计数。应用免疫组化法分别检测OPN、NF-κB在原发癌灶和瘤芽的表达。结果:瘤芽位于肿瘤侵袭前沿,是失去极性的去分化癌细胞,呈孤立或不规则小梁状分布。瘤芽程度和OPN在大肠癌原发癌灶的强阳性表达在A与C组间的差异具有显著性(P<0.01)。OPN在瘤芽的阳性表达在A和C组以及B和C组的差异均具有显著性(P<0.01)。各组间NF-κB在原发癌灶、瘤芽的表达无显著差别。结论:瘤芽BD(+)、OPN在原发癌灶的强阳性表达均提示大肠癌发生肝转移的可能性较大。如将瘤芽分布特征结合OPN在瘤芽的表达,则可提高预测的准确性,可以考虑作为预测大肠癌术后肝转移的生物学指标。

A Simple Biological Indicator for Predicting Liver Metastasis after Resection of Advanced Colorectal Carcinoma

Objective: To explore the distribution of tumor budding and the expression of osteopontin in primary colorectal cancer and tumor buds in order to evaluate whether these factors could be used as a simple biological indicator for predicting liver metastasis after surgery to remove colorectal carcinoma. Methods: Cases diagnosed as Duke's stage C were divided into three groups, namely, group A with synchronous liver metastasis, group B with heterochronous liver metastasis, and group C with no liver metastasis. After H&E staining, attention was focused on observing the distribution characteristics of tumor budding at the invasive front of colorectal carcinoma and recording the numbers accurately.The expression of osteopontin and NF- κ B in primary lesions and tumor buds was examined using im-munohistochemistry. Results: Tumor budding was defined as depolarized and dedifferentiated cancer cells with isolated and irregular trabecular form ahead of the invasive front of the lesion. Both the degree of tumor budding and the strong positive expression of osteopontin in primary colorectal cancer showed a significant difference only between group A and group B (P<0.01). The positive expression of osteopontin in tumor buds showed a significant difference between groups A and C and between groups B and C (P<0.01). As for the expression of NF- κ B, there is no significant difference among the 3 groups. Conclusion: Both tumor budding degree (BD)(+) and the strong positive expression of osteopon-tin in primary colorectal cancer indicate increased risk of liver metastasis following colorectal carcinoma. If the distribution characteristics of tumor budding are assessed in combination with the expression of osteopontin within the tumor buds, the predictive accuracy is increased and can be used as a biological indicator for predicting liver metastasis after surgery to remove colorectal carcinoma.