Tanaka S, Haruma K, Oh-E H, Nagata S, Hirota Y, Furudoi A, Amioka T, Kitadai Y, Yoshihara M, Shimamoto F
Department of Endoscopy, Hiroshima University School of Medicine, Minami-ku, Hiroshima 734-8551, Japan.
Oncol Rep. 2000 Jul-Aug;7(4):783-8. doi: 10.3892/or.7.4.783.
The deepest invasive portion of colorectal carcinoma (CRC) is considered to be the part, which ultimately will invade, spread locally and give metastasis. We have previously reported that histologic differentiation at the deepest invasive portion of CRC closely correlate with metastatic potential and is useful in understanding the curability of endoscopic mucosal resection (EMR). The aim of this study is to clarify the conditions of curative EMR for CRC with submucosally (sm) massive invasion. A total of 521 cases with sm invasive CRC (Group A, 470 surgically resected cases; Group B, 51 followed-up cases after EMR) were studied. The depth of sm invasion was defined as the practically measured distance from muscularis mucosae. Histologic subclassification was performed at the deepest invasive tumor margin as: well-differentiated (W), moderately differentiated (M) and poorly differentiated (Por). By assessing glandular configuration and cellular arrangement, M type was further subdivided into two different groups; moderately-well differentiated (Mw) and moderately-poorly differentiated (Mp). In group A, lymph node (LN) metastasis was detected in 45 (9.6%) of 470 cases. W or Mw lesions showed LN metastasis in 4.9% (19/388). Mp or Por lesions showed LN metastasis in 37.3% (25/67) (W/Mw vs Mp/Por; p<0.01). Of 45 cases with LN metastasis that could be measured the practical distance of sm invasion, W or Mw lesions showed no LN metastasis in cases within 1,500 micrometer invasion. However, Mp or Por lesions showed LN metastasis in cases within 1,500 micrometer invasion (5/15, 33.3%, minimum 400 micrometer invasion; so-called scanty invasion). In group B, none of 51 cases died of LN metastasis and showed no other metastasis, although 17 cases (33.3%) showed an sm invasion more than 1,500 micrometer. These results indicated that CRC even with sm massive invasion can be cured by complete EMR on conditions that the depth of sm invasion is within 1,500 micrometer and histologic grade at the deepest invasive portion is W or Mw, if there are no vessel involvement. However, cases with Mp or Por grade were not curative by EMR, even if they showed an sm scanty invasion.
结直肠癌（CRC）最深的浸润部分被认为是最终会发生浸润、局部扩散并发生转移的部分。我们之前报道过，CRC最深浸润部分的组织学分化与转移潜能密切相关，有助于理解内镜黏膜切除术（EMR）的可治愈性。本研究的目的是阐明黏膜下（sm）大量浸润的CRC行根治性EMR的条件。共研究了521例sm浸润性CRC患者（A组，470例行手术切除的病例；B组，51例EMR术后随访病例）。sm浸润深度定义为从黏膜肌层实际测量的距离。在最深浸润肿瘤边缘进行组织学亚分类：高分化（W）、中分化（M）和低分化（Por）。通过评估腺管结构和细胞排列，M型进一步细分为两个不同的组：中高分化（Mw）和中低分化（Mp）。在A组中，470例中有45例（9.6%）检测到淋巴结（LN）转移。W或Mw病变的LN转移率为4.9%（19/388）。Mp或Por病变的LN转移率为37.3%（25/67）（W/Mw与Mp/Por比较；p<0.01）。在45例可测量sm浸润实际距离的LN转移病例中，W或Mw病变在浸润1500微米以内的病例中未出现LN转移。然而，Mp或Por病变在浸润1500微米以内的病例中出现了LN转移（5/15，33.3%，最小浸润400微米；即所谓的微小浸润）。在B组中，51例均未死于LN转移，也未出现其他转移，尽管有17例（33.3%）的sm浸润超过1500微米。这些结果表明，如果没有血管侵犯，即使是sm大量浸润的CRC，在sm浸润深度在1500微米以内且最深浸润部分的组织学分级为W或Mw的情况下，通过完整的EMR也可治愈。然而，Mp或Por分级的病例，即使表现为sm微小浸润，EMR也无法治愈。
