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Tumor budding is an independent adverse prognostic factor in pancreatic ductal adenocarcinoma.

肿瘤出芽是胰腺导管腺癌中一个独立的预后不良预测因子

O'Connor K,Li-Chang HH,Kalloger SE,Peixoto RD,Webber DL,Owen DA,Driman DK,Kirsch R,Serra S,Scudamore CH,Renouf DJ,Schaeffer DF

Abstract

Tumor budding is a well-established adverse prognostic factor in colorectal cancer. However, the significance and diagnostic reproducibility of budding in pancreatic carcinoma requires further study. We aimed to assess the prognostic significance of tumor budding in pancreatic ductal adenocarcinoma, determine its relationship with other clinicopathologic features, and assess interobserver variability in its diagnosis. Tumor budding was assessed in 192 archival cases of pancreatic ductal adenocarcinoma using hematoxylin and eosin (H&E) sections; tumor buds were defined as single cells or nonglandular clusters composed of <5 cells. The presence of budding was determined through assessment of all tumor-containing slides, and associations with clinicopathologic features and outcomes were analyzed. Six gastrointestinal pathologists participated in an interobserver variability study of 120 images of consecutive tumor slides stained with H&E and cytokeratin. Budding was present in 168 of 192 cases and was associated with decreased overall survival (P=0.001). On multivariable analysis, tumor budding was prognostically significantly independent of stage, grade, tumor size, nodal status, lymphovascular invasion, and perineural invasion. There was substantial agreement among pathologists in assessing the presence of tumor budding using both H&E (K=0.63) and cytokeratin (K=0.63) stains. The presence of tumor budding is an independent adverse prognostic factor in pancreatic ductal carcinoma. The assessment of budding with H&E is reliable and could be used to better risk stratify patients with pancreatic ductal adenocarcinoma.

摘要

众所周知,肿瘤出芽是结直肠癌预后不良的预测因子之一。然而,胰腺癌中肿瘤出芽的重要性及诊断的可复性还有待进一步研究。本研究旨在评价肿瘤出芽在胰腺导管腺癌中的预测价值,明确它与其他临床病理特征的关系,评估其诊断在观察者间的变异。应用192例存档胰腺导管腺癌病例的HE切片对肿瘤出芽进行评估;肿瘤芽被定义为由单个细胞或,由<5个细胞所构成的细胞簇。通过对所有包含肿瘤的切片进行评估来判断是否有肿瘤出芽,并分析了其与临床病理特征及结局的联系。6位胃肠病理学家参与了以肿瘤连续HE切片及CK染色切片构成的120幅图像为对象的观察者间变异的研究。192例病例中168例可见出芽,且与总生存率的降低显著相关((P=0.001)。多变量分析显示,肿瘤出芽是独立于分期、分级、肿瘤大小、淋巴结情况、淋巴血管侵犯、神经侵犯的重要预测因子。在应用HE切片(K=0.63)和CK染色(K=0.63)评价是否存在肿瘤出芽方面,病理学家间意见基本一致。肿瘤出芽是胰腺导管腺癌中一个独立的预后不良预测因子。应用HE切片进行肿瘤出芽的评估是可靠的,并可用于完善胰腺导管腺癌患者的风险分级。

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