Akasu T, Kondo H, Moriya Y, Sugihara K, Gotoda T, Fujita S, Muto T, Kakizoe T
Department of Surgery, National Cancer Center Hospital, Tokyo, Japan.
World J Surg. 2000 Sep;24(9):1061-8. doi: 10.1007/s002680010151.
The purpose of this study was to evaluate the accuracy of preoperative staging by endorectal ultrasonography (EUS) and its contribution to treatment of early stage rectal cancer (ESRC). The results of EUS for 154 consecutive patients with ESRC (pTis to pT2) were compared prospectively with histologic findings, assessed according to the TNM classification. Results of treatment selection and long-term outcomes were analyzed retrospectively. There were 35 patients histologically staged as pTis, 8 as pT1-slight (invasion confined to the superficial one-third of the submucosa), 37 as pT1-massive (invasion extending to the deeper submucosa), and 74 as pT2. The equipment used was an echoendoscope GF-UM2 or GF-UM3 (Olympus, Tokyo, Japan). Sensitivity/specificity/overall accuracy rates for detection of slight submucosal invasion, massive submucosal invasion, and muscularis propria invasion were 99%/74%/96%, 98%/88%/97%, and 97%/93%/96%, respectively. Incidences of lymph node metastasis in pTis, pTis to pT1-slight, pT1, pT1-massive, and pT2 cases were 0%, 0%, 18%, 22%, and 30%, respectively. Incidences of lymph node metastasis in ESRCs staged by EUS (u) as uTis, uT1-slight, uT1-massive, uT2, and uT3 by EUS were 0%, 0%, 26%, 36%, and 64%, respectively. Sensitivity, specificity, and overall accuracy rates for detection of positive nodes in overall ESRCs were 53%, 77%, and 72%, respectively. Of the 43 patients with pTis to pT1-slight tumors, 22 underwent endoscopic polypectomy or local excision, 20 radical surgery, and 1 radical surgery after endoscopic polypectomy due to vascular invasion. All these patients are alive and all but one (who refused radical surgery due to vascular invasion after local excision and developed liver and lung metastases) are disease-free. Of the 37 patients with pT1-massive tumors, 34 underwent radical surgery and 3 transcoccygeal segmental resection. All these patients are alive disease-free except for one who died of peritoneal carcinomatosis after radical surgery. All patients with pT2 tumors underwent radical surgery. The overall 5-year survival rates for pTis, pT1, and pT2 cases were 100%, 98%, and 97%, respectively. EUS is an accurate method for evaluating invasion depth in ESRC. Patients with uTis or uT1-slight tumors staged by EUS are at low risk of positive nodes and good candidates for endoscopic polypectomy or local excision. Those with uT1-massive or uT2 lesions should be treated with a radical operation because of the high incidence of positive nodes.
本研究旨在评估经直肠超声检查（EUS）进行术前分期的准确性及其对早期直肠癌（ESRC）治疗的贡献。对154例连续的ESRC患者（pTis至pT2）的EUS结果与根据TNM分类评估的组织学结果进行前瞻性比较。回顾性分析治疗选择结果和长期预后。组织学分期为pTis的患者有35例，pT1-轻度（侵犯局限于黏膜下层的浅表三分之一）的有8例，pT1-重度（侵犯延伸至更深的黏膜下层）的有37例，pT2的有74例。使用的设备是超声内镜GF-UM2或GF-UM3（日本东京奥林巴斯公司）。检测轻度黏膜下侵犯、重度黏膜下侵犯和固有肌层侵犯的敏感度/特异度/总体准确率分别为99%/74%/96%、98%/88%/97%和97%/93%/96%。pTis、pTis至pT1-轻度、pT1、pT1-重度和pT2病例的淋巴结转移发生率分别为0%、0%、18%、22%和30%。EUS分期为uTis、uT1-轻度、uT1-重度、uT2和uT3的ESRC患者的淋巴结转移发生率分别为0%、0%、26%、36%和64%。总体ESRC患者检测阳性淋巴结的敏感度、特异度和总体准确率分别为53%、77%和72%。在43例pTis至pT1-轻度肿瘤患者中，22例行内镜下息肉切除术或局部切除术，20例行根治性手术，1例因血管侵犯在内镜下息肉切除术后行根治性手术。所有这些患者均存活，除1例（因局部切除后血管侵犯拒绝根治性手术并发生肝肺转移）外均无疾病。在37例pT1-重度肿瘤患者中，34例行根治性手术，3例行经尾骨节段切除术。除1例根治性手术后死于腹膜癌外，所有这些患者均存活且无疾病。所有pT2肿瘤患者均行根治性手术。pTis、pT1和pT2病例的总体5年生存率分别为100%、98%和97%。EUS是评估ESRC浸润深度的准确方法。EUS分期为uTis或uT1-轻度肿瘤的患者淋巴结阳性风险低，是内镜下息肉切除术或局部切除术的良好候选者。那些uT1-重度或uT2病变患者因淋巴结阳性发生率高应行根治性手术治疗。
