Nishi Masataka, Moriyasu Fuminori
4th Department of Internal Medicine, Tokyo Medical University.
Nihon Shokakibyo Gakkai Zasshi. 2002 Jul;99(7):769-78.
The following studies were undertaken using specimens of submucosal invasive colorectal cancer surgically or endoscopically resected from 104 patients: 1) measurement of the depth of submucosal invasion; 2-a) histological reevaluation of colon sm cancer by scoring of the degree of histological differentiation using a modified Gleason's grading system proposed for prostatic cancer; and 2-b) immunohistological evaluation of E-cadherin, a cell adhesion factor. Lymphatic node metastasis occurred in no case with the depth of submucosal invasion of less than 1,000 microns. In the histological reevaluation, high incidence of lymphatic metastasis was noted in the high-score group, while lymphatic node metastasis was not seen in any patients in the low-score group. Immunohistological evaluation of E-cadherin showed that the destructive pattern is correlated with lymphatic metastasis, suggesting that weakening of the cell adhesive factor was related to a decline in the degree of differentiation of the tumor. Findings obtained in the present study suggest that endoscopic therapy is indicated for colon cancer measuring less than 1,000 microns and that its indication can be expanded to colorectal cancer with the depth of submucosal invasion of more than 1,000 microns by adding histological reevaluation.
以下研究使用了从104例患者手术或内镜切除的黏膜下浸润性结直肠癌标本进行：1）测量黏膜下浸润深度；2-a）通过使用为前列腺癌提出的改良Gleason分级系统对组织学分化程度进行评分，对结肠sm癌进行组织学重新评估；以及2-b）对细胞粘附因子E-钙粘蛋白进行免疫组织学评估。黏膜下浸润深度小于1000微米的病例均未发生淋巴结转移。在组织学重新评估中，高分组合并淋巴结转移的发生率较高，而低分组合并任何患者均未发现淋巴结转移。E-钙粘蛋白的免疫组织学评估显示，破坏模式与淋巴结转移相关，提示细胞粘附因子减弱与肿瘤分化程度下降有关。本研究结果表明，内镜治疗适用于直径小于1000微米的结肠癌，通过增加组织学重新评估，其适应证可扩大至黏膜下浸润深度超过1000微米的结直肠癌。
