作者：李正勇，郑希敏，王凯旋，刘祺

单位：湖南师范大学附属第一医院湖南省人民医院 普通外科， 湖南 长沙 410000

Authors:  Li Zhengyong, Zheng Ximin, Wang Kaixuan, Liu Qi

Unit:  Department of General Surgery, the First Affiliated Hospital of Hunan Normal University, Hunan Provincial People's Hospital, Changsha 410000, Hunan, China

摘要：

目的 探讨肿瘤出芽对早期结直肠癌内镜切除术后复发风险评估的临床意义。方法 回顾性收集自2011年1月到2016年12月湖南省人民医院经内镜下治疗的低复发风险的34例T1N0M0期结直肠癌患者的临床病理资料。分析患者的临床病理特征及5年无病生存情况。结果 34例患者中,高级别肿瘤出芽9例(26.5%)、中级别肿瘤出芽12例(35.3%)、低级别肿瘤出芽13例(38.2%)。其中24例(70.6%)在5年随访期间内出现肿瘤复发,10(29.4%)例未出现肿瘤复发,低级别肿瘤出芽复发5例(38.5%),中级别肿瘤出芽复发10例(83.3%),高级别肿瘤出芽复发9例(100%);在5年随访期内3例(8.8%)患者出现肿瘤相关性死亡。高级别肿瘤出芽多为广基底、中分化、5年内多复发(χ2值分别为9.181、8.821、10.432,均P<0.05),经单因素分析显示经内镜治疗后患者的5年无病生存期与肿瘤出芽、基底部类型、分化类型明显相关(P值分别为0.002、0.012、0.001),多因素Cox回归分析显示,肿瘤出芽级别显著影响无病生存期(P=0.039)。结论 肿瘤出芽是提示结直肠癌经内镜切除治疗后早期复发及转移的重要因素,肿瘤出芽计数可作为结直肠癌经内镜切除术后病理诊断的常规项目,便于临床进行预后评估;对病理结果提示高级别肿瘤出芽的患者,建议进一步追加外科手术或其他相关治疗。

关键词：早期结直肠癌; 内镜治疗; 肿瘤出芽; 风险评估

Abstract：

Objective The purpose of this study was to investigate the clinical significance of tumor budding in the risk assessment of recurrence after endoscopic resection for early colorectal cancer （CRC）. Method The data of 34 patients with stage T1N0M0 colorectal cancer who received endoscopic treatment in Hunan Provincial People's Hospital from January 2011 to December 2016 were retrospectively collected. The clinicopathological characteristics and 5 -year disease-free survival of the patients were analyzed. Results Among the 34 patients, 9 cases （26.5%） had high-grade tumor buds, 12 cases （35.3%） had medium-grade tumor buds, and 13 cases （38.2%） had low-grade tumor buds. During the 5-year follow-up, 24 patients （70.6%） had tumor recurrence, 10 patients （29.4%） had no tumor recurrence, low-grade tumor buds had 5 patients （38.5%） recurrence, medium-grade tumor buds had 10 patients （83.3%） recurrence, and high-grade tumor buds had 9 patients （100%） recurrence. Tumor-related deaths occurred in 3 patients（8.8%） during the 5-year follow-up period. In this study, we found that the tumors in the high-grade budding group were mostly broad -based, moderately differentiated, and more recurrent within 5 years （χ2 =9.181、8.821、10.432, all P＜0.05）, Univariate analysis showed that the 5-year disease-free survival time after endoscopic treatment was significantly correlated with tumor germination, basal type and differentiation type （P=0.002, 0.012, 0.001）. Multivariate Cox regression analysis showed that tumor germination level significantly affected the disease-free survival time （P=0.039 ）. Conclusion Tumor budding is an important factor for early recurrence and metastasis of colorectal cancer after endoscopic resection. The count of tumor budding can be used as a routine item for pathological diagnosis of colorectal cancer after endoscopic resection, which is convenient for clinical prognostic evaluation. For patients with high-grade tumor sprouting, additional surgery or other related treatment are recommended.

Key Words:  Early stage colorectal cancer; Endoscopy; Tumor budding; Risk assessment