Sakuragi Masako, Togashi Kazutomo, Konishi Fumio, Koinuma Koji, Kawamura Yutaka, Okada Masaki, Nagai Hideo
Department of Surgery, Omiya Medical Center, Jichi Medical School, 1-847 Amanuma, Saitama City, Saitama Prefecture 330-8503, Japan.
Dis Colon Rectum. 2003 Dec;46(12):1626-32. doi: 10.1007/BF02660767.
Selective endoscopic resection may cure early colorectal cancer (T1), but the management is controversial. There is concern about the small risk of lymph node metastasis, which will not be treated by endoscopic resection alone. The authors sought predictive markers of lymph node metastasis to assist patient management.
The authors retrospectively analyzed consecutive cases of T1 stage colorectal cancer resected using endoscopic resection or bowel surgery over the period 1979 to 2000. The risk of lymph node metastasis was analyzed using logistic regression model for the markers selected by univariate analysis: the type of initial treatment, depth of submucosal invasion, lymphatic channel invasion, differentiation of histology, and invasive front histology.
Two hundred seventy-eight patients were available for study. Twenty-one had lymph node metastasis. Depth of submucosal invasion (> or = 2,000 microm) and lymphatic channel invasion significantly predicted risk of lymph node metastasis in multivariate analysis. When these two factors were adopted for the prediction of lymph node metastasis, sensitivity, specificity, positive predictive value, and negative predictive value were 100, 55.6, 15.6, and 100 percent, respectively.
Depth of submucosal invasion and lymphatic channel invasion were accurate predictive factors for lymph node metastasis. These two factors could be used in selecting appropriate cases for surgery after endoscopic resection.
选择性内镜切除可能治愈早期结直肠癌（T1期），但其治疗方案仍存在争议。对于内镜切除无法单独处理的小概率淋巴结转移风险，人们存在担忧。作者旨在寻找淋巴结转移的预测标志物以辅助患者管理。
作者回顾性分析了1979年至2000年期间采用内镜切除或肠道手术切除的T1期结直肠癌连续病例。使用逻辑回归模型对单因素分析所选标志物的淋巴结转移风险进行分析：初始治疗类型、黏膜下浸润深度、淋巴管浸润、组织学分化及浸润前沿组织学。
278例患者可供研究。21例发生淋巴结转移。多因素分析中，黏膜下浸润深度（≥2000微米）和淋巴管浸润显著预测淋巴结转移风险。当采用这两个因素预测淋巴结转移时，敏感度、特异度、阳性预测值和阴性预测值分别为100%、55.6%、15.6%和100%。
黏膜下浸润深度和淋巴管浸润是淋巴结转移的准确预测因素。这两个因素可用于选择内镜切除术后适合手术的病例。
