转移性淋巴结的组织学分级与直肠癌的预后

Histologic grade of metastatic lymph node and prognosis of rectal cancer.

作者信息

Takahashi K, Mori T, Yasuno M

机构信息

Department of Surgery, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan.

出版信息

Dis Colon Rectum. 2000 Oct;43(10 Suppl):S40-6. doi: 10.1007/BF02237225.

DOI:10.1007/BF02237225

PMID:11052477

Abstract

PURPOSE

It is important to identify cases with a high risk of recurrence to improve the prognosis of colorectal cancer. In this study the difference between the histology of the primary lesion and that of the metastatic lymph node was investigated in an attempt to identify the cases with a high risk of recurrence.

METHODS

One-hundred eighty-five patients with Dukes C rectal cancer who had undergone curative resection were investigated. The histologic grade of the metastatic lymph node was determined and compared with other clinicopathologic factors to determine its significance as a prognostic factor.

RESULTS

The histologic grade was the same between the primary lesion and the metastatic lymph node in 46.2 percent of all cases, although in the group with well-differentiated adenocarcinoma at the primary lesion the concordance was only 29.5 percent. In the group with well-differentiated adenocarcinoma at the primary lesion, the five-year survival rate was 75.3, 64, and 25 percent in the groups with well-differentiated, moderately differentiated, and poorly differentiated adenocarcinoma at the metastatic lymph node, respectively. The differences between the survival rates of well-differentiated and poorly differentiated adenocarcinoma at the metastatic lymph node were statistically significant (P < 0.05). According to multivariate analysis the histologic grade of primary lesion was the most significant prognostic factor (hazard ratio: 2.2801, P = 0.0008). However, in well-differentiated adenocarcinoma of patients with Dukes C rectal cancer at the primary lesion, the histology of metastatic lymph node was also an important prognostic factor.

CONCLUSIONS

It is clear that the histologic grade between the primary lesion and metastatic lymph node was frequently different, especially in the group with well-differentiated adenocarcinoma at the primary lesion. The analysis of the metastatic lymph node was considered to have additional importance for the prediction of prognosis.

摘要

目的

识别具有高复发风险的病例对于改善结直肠癌的预后很重要。在本研究中，对原发性病变与转移性淋巴结的组织学差异进行了研究，以试图识别具有高复发风险的病例。

方法

对185例接受了根治性切除的Dukes C期直肠癌患者进行了研究。确定转移性淋巴结的组织学分级，并与其他临床病理因素进行比较，以确定其作为预后因素的意义。

结果

在所有病例中，46.2% 的原发性病变与转移性淋巴结的组织学分级相同，尽管在原发性病变为高分化腺癌的组中，一致性仅为29.5%。在原发性病变为高分化腺癌的组中，转移性淋巴结为高分化、中分化和低分化腺癌的组的五年生存率分别为75.3%、64% 和25%。转移性淋巴结高分化和低分化腺癌的生存率差异具有统计学意义（P < 0.05）。根据多因素分析，原发性病变的组织学分级是最显著的预后因素（风险比：2.2801，P = 0.0008）。然而，在原发性病变为Dukes C期直肠癌的高分化腺癌患者中，转移性淋巴结的组织学也是一个重要的预后因素。