中国实用外科杂志

中国实用外科杂志 ›› 2025, Vol. 45 ›› Issue (02): 208-213.DOI: 10.19538/j.cjps.issn1005-2208.2025.02.14

• 论著 • 上一篇    下一篇

肿瘤浸润前沿间质类型与结直肠腺癌侵袭能力及预后研究

彭    辉，张志发，伍颖君   

  1. 广东省中医院病理科，广东广州 510120
  • 出版日期:2025-02-01 发布日期:2025-02-26

  • Online:2025-02-01 Published:2025-02-26

摘要： 目的    探讨肿瘤浸润前沿间质类型与结直肠腺癌的侵袭能力及预后的关系。方法    采用回顾性研究方法收集2014年1月1日至2015年12月31日于广东省中医院接受根治性切除术的155例Ⅲ期中分化结直肠腺癌病人的临床病理资料，按肿瘤浸润前沿间质类型分为成熟型（34例）、中间型（92例）及不成熟型（29例）；比较三组病人的临床资料及肿瘤侵袭能力；Kaplan-Meier法比较三组病人生存率的差异，绘制生存曲线并用log-rank检验分析三组间总生存期（OS）的差异；Cox比例风险回归模型分析结直肠腺癌术后OS的影响因素。结果    成熟型、中间型、不成熟型T4期的比例依次为8.8%、27.2%、34.5%，三组间T分期的分布、脉管侵犯的比例、神经侵犯的比例差异有统计学意义（P<0.05）；其中，与成熟型相比，中间型、不成熟型T分期的分布，不成熟型脉管侵犯的比例和中间型神经侵犯的比例更高，差异有统计学意义（P<0.05）。间质类型与T分期（r=0.249，P=0.001）、脉管侵犯
（r=0.200，P=0.009）、神经侵犯（r=0.181，P=0.019）呈正相关，与N分期无关（r=-0.008，P=0.917）；不同浸润前沿间质类型的OS差异有统计学意义（log-rank χ2=6.39，P=0.041）；成熟型病人的3年和5年OS长于中间型和不成熟型，差异有统计学意义（P<0.05）。年龄＞60岁（HR=1.94，95% CI 1.02~3.72，P=0.046）是影响结直肠腺癌术后OS的独立危险因素，无神经侵犯（HR=0.41，95% CI 0.23~0.72，P=0.002）和浸润前沿间质类型为成熟型或中间型（HR=0.54，95% CI 0.29~0.99，P=0.048)是影响结直肠腺癌术后OS的独立保护因素。结论    肿瘤浸润前沿间质类型越不成熟，侵袭能力越强，预后越差。

关键词: Ⅲ期结直肠腺癌, 中分化腺癌, 肿瘤浸润前沿间质类型

Abstract: To investigate the relationship between the type of desmoplastic reaction  at the tumor invasion front and the invasive ability and prognosis of colorectal adenocarcinoma. Methods    A retrospective study was conducted. The clinicopathological data of 155 patients with stage Ⅲ moderately differentiated colorectal adenocarcinoma who underwent radical resection at Guangdong Provincial Hospital of Traditional Chinese Medicine from January 1, 2014, to December 31, 2015, were collected. The patients were divided into mature type (34 cases), intermediate type (92 cases), and immature type (29 cases) according to the type of desmoplastic reaction  at the tumor invasion front. The clinical data and tumor invasion ability of the three groups were compared. The Kaplan-Meier method was used to compare the differences in survival rates among the three groups. The survival curves were drawn and the differences in overall survival (OS) among the three groups were analyzed using the log-rank test. The Cox proportional hazard regression model was used to analyze the influencing factors for OS after colorectal adenocarcinoma surgery. Results    The incidence of T4 in mature, intermediate, and immature types was 8.8%, 27.2%, and 34.5%, respectively. There were statistically significant differences in the distribution of T stages, the proportion of vascular invasion, and the proportion of nerve invasion among the three groups (P<0.05). Among them, compared with the mature type, the T stage distribution, the proportion of immature vascular invasion, and the proportion of intermediate nerve invasion in the intermediate type and the immature type were different, and the difference was statistically significant (P<0.05). The desmoplastic reaction  was positively correlated with T stage (r=0.249, P=0.001), lymphovascular invasion (r=0.200, P=0.009), and neural invasion (r=0.181, P=0.019), but was not related to N stage (r=-0.008, P=0.917). There was a significant difference in the OS of different types of desmoplastic reaction (log-rank χ2=6.39, P=0.041), and the 3-year and 5-year OS of patients with mature type are longer than patients with intermediate and immature types (P<0.05). Age>60 years (HR=1.94, 95%CI 1.02-3.72, P=0.046) was an independent risk factor for OS after colorectal adenocarcinoma surgery, while negative neural invasion (HR=0.41, 95% CI 0.23-0.72, P=0.002) and mature or intermediate desmoplastic reaction at the invasive front (HR=0.54, 95%CI 0.29-0.99, P=0.048) were independent protective factors for OS after colorectal adenocarcinoma surgery. Conclusion    The more immature the desmoplastic reaction at the tumor infiltration front, the stronger the invasive ability and the worse the prognosis.

Key words: Stage Ⅲ colorectal cancer, moderately differentiated adenocarcinoma, desmoplastic reaction , at the tumor infiltration front