Bayar S, Saxena R, Emir B, Salem R R
Yale University School of Medicine, Department of Surgery, Section of Surgical Oncology, New Haven, CT 06520, USA.
Eur J Surg Oncol. 2002 Jun;28(4):413-7. doi: 10.1053/ejso.2002.1254.
The aim of this study was to evaluate the role of histopathological and demographic characteristics in predicting lymph node metastasis in patients with adenocarcinoma of the rectum confined to the mucosal and submucosal layers.
Fifty-nine patients with early rectal cancer underwent resection of the rectum including lymph nodes and five showed lymph node metastasis (8.6%). Pathology slides of these patients were reviewed by a single pathologist. Demographic and clinical characteristics of these 59 patients were correlated with the existence of nodal metastasis. Formal tests of comparability were carried out by using Fisher's exact test. Logistic regression models were fitted to data to examine possible relationships with 12 covariates measured from each patient and to obtain corresponding odds ratios (as well as a 95% confidence interval for the odds ratios). These covariates included age at surgery, gender, morphology, histology, degree of differentiation, Haggitt's classification for polyps according to the level of invasion, lymphatic and venous invasion, desmoplastic reaction, degree of lymphocytic invasion, presence of lymphoid follicles and presence of infiltrating or pushing margins.
A significantly higher rate of lymph node metastasis occurs in the presence of venous invasion (P < 0.01). Venous invasion was present in three of five (60%) patients with lymph node metastasis and only four of 54 (7%) patients without lymph node metastasis. Other variables did not achieve statistical significance.
Only the presence of venous invasion was found to be highly significant. The odds ratio of lymph node metastasis increased 18-fold for a patient who had venous invasion compared with a patient who did not. This suggests that the presence of venous invasion in early rectal cancer may provide valuable information to determine which patients would benefit from radical surgery, or adjuvant radiation therapy after sphincter-sparing surgery owing to an increased risk of lymph node metastasis.
本研究旨在评估组织病理学和人口统计学特征在预测局限于黏膜层和黏膜下层的直肠癌患者发生淋巴结转移中的作用。
59例早期直肠癌患者接受了包括淋巴结清扫的直肠切除术，其中5例出现淋巴结转移（8.6%）。由一名病理学家对这些患者的病理切片进行复查。将这59例患者的人口统计学和临床特征与淋巴结转移情况进行关联分析。采用Fisher精确检验进行可比性的正式检验。对数据拟合逻辑回归模型，以检验与每位患者测量的12个协变量之间的可能关系，并获得相应的比值比（以及比值比的95%置信区间）。这些协变量包括手术年龄、性别、形态学、组织学、分化程度、根据息肉浸润水平的Haggitt分类、淋巴管和静脉侵犯、促纤维组织增生反应、淋巴细胞浸润程度、淋巴滤泡的存在以及浸润性或推挤性边缘的存在。
静脉侵犯患者的淋巴结转移率显著更高（P<0.01）。5例有淋巴结转移的患者中有3例（60%）存在静脉侵犯，而54例无淋巴结转移的患者中只有4例（7%）存在静脉侵犯。其他变量未达到统计学显著性。
仅发现静脉侵犯具有高度显著性。与无静脉侵犯的患者相比，有静脉侵犯的患者发生淋巴结转移的比值比增加了18倍。这表明早期直肠癌中静脉侵犯的存在可能为确定哪些患者因淋巴结转移风险增加而将从根治性手术或保留括约肌手术后的辅助放疗中获益提供有价值的信息。
