作者：林智1，叶倩文2，颜兵2

单位：1.琼中县人民医院（郑州大学琼中医院） 外科，海南 琼中 572900；2.解放军总医院海南医院 肿瘤科，海南 三亚 572000

Authors: Lin Zhi1, Ye Qianwen2, Yan Bing2

Unit: 1.Department of Surgery , People ’ s Hospital of Qiongzhong County （Qiongzhong Hospital of Zhengzhou

University）,Qiongzhong 572900, Hainan, China；2.Department of Oncology, Hainan Hospital of Chinese PLA General Hospital, Sanya 572000, Hainan, China

摘要：

目的 探索肿瘤出芽(TB)对术前癌胚抗原(CEA)正常的Ⅰ～Ⅲ期结直肠癌患者预后价值。方法 回顾性收集解放军总医院海南医院经手术完整切除后病理确诊且术前CEA在正常范围内的Ⅰ～Ⅲ期结直肠癌病例87例,通过苏木精-伊红染色判读TB后将患者分为TB低组和TB高组,分析两组患者不同临床病理参数的不同及无病生存(DFS)期、总生存(OS)期的差异。结果TB高组患者更多表现为存在淋巴结转移(N1+2)、Ⅲ期(均P <0.01);TB低组患者不论是DFS (Log rank=4.48,P=0.03)还是OS (Log rank=5.74,P=0.02)均优于TB高组;单因素分析显示TB是DFS和OS的预测因子,但多因素分析仅显示TB是OS的独立预测因子(HR=3.25,95%CI:1.07～9.83,P=0.04)。结论 在CEA正常的Ⅰ～Ⅲ期结直肠癌患者中,TB对患者预后判断具有重要价值,TB较低的患者预后优于较高的患者。

关键词：结直肠癌；肿瘤出芽；癌胚抗原;无病生存期；总生存期

Abstract：

Objective To explore the prognostic implication of tumor budding （TB） in stageⅠ-Ⅲ colorectal cancer （CRC） patients with a normal pre-operative carcinoembryonic antigen （CEA）. Method A total of 87 patients were retrospectively enrolled in Hainan hospital of Chinese PLA general hospital with a normal pre -operative CEA, the TB was read by hematoxylin eosin staining and patients were subsequently divided into TB -low and TB -high subgroups, the differences of different clinicopathological parameters as well as disease free survival（DFS ）, overall survival（OS ）were estimated. Result TB -high was more apparent in patients with lymph node metastasis（N1+2 ）and stage Ⅲ（all P＜0.01）; TB-low patients were superior in DFS（Log rank=4.48, P=0.03 and OS（Log rank=5.74, P=0.02 compared with the TB-high ones; TB was a risk factor for both DFS and OS by univariate analysis, but was an independent risk factor only for OS （HR=3.25, 95%CI: 1.07-9.83, P=0.04） by multivariate analysis. Conclusion In CRC patients with a normal pre-operative CEA, TB plays an important prognostic role, the ones with TB-low would have a good survival.

Key Words: Colorectal cancer; Tumor budding; Carcinoembryonic antigen; Disease free survival; Overall survival; Prognosis