Yamamoto Seiichiro, Watanabe Masahiko, Hasegawa Hirotoshi, Baba Hideo, Yoshinare Kentaro, Shiraishi Junichi, Kitajima Masaki
Department of Surgery, Keio University School of Medicine, Tokyo, Japan.
Hepatogastroenterology. 2004 Jul-Aug;51(58):998-1000.
BACKGROUND/AIMS: The purpose of this study was to evaluate the risk of lymph node metastasis in patients with T1 colorectal carcinoma based on a uniform histopathology system, and to accomplish guidelines for additional surgery for endoscopically or locally removed T1 colorectal carcinoma.
A review was performed of 301 patients who underwent curative resection for T1 colorectal carcinoma between January 1970 and March 2001. The following clinicopathologic variables were evaluated using univariate and multivariate analysis: sex, age, location, size of tumor, macroscopic appearance, depth of submucosal invasion, lymphovascular invasion, and histologic grade. Lesions were subdivided according to the depth of submucosal invasion: sm1, submucosal invasion up to 500 microm from the muscularis mucosa; sm2, submucosal invasion between 500 and 1000 microm; sm3, submucosal invasion beyond 1000 microm.
The overall lymph node metastasis rate was 6.3 per cent (19 of 301). Depth of submucosal invasion (sm3) and presence of lymphovascular invasion were significant risk factors for lymph node metastasis both univariately and multivariately.
The findings of the current study demonstrated that significant risk factors for lymph node metastasis were level of submucosal invasion (sm3) and the presence of lymphovascular invasion. Surgery is indicated for patients with adverse factors.
背景/目的：本研究旨在基于统一的组织病理学系统评估T1期结直肠癌患者的淋巴结转移风险，并制定针对经内镜或局部切除的T1期结直肠癌患者进行额外手术的指南。
对1970年1月至2001年3月间接受T1期结直肠癌根治性切除术的301例患者进行回顾性研究。使用单因素和多因素分析评估以下临床病理变量：性别、年龄、肿瘤位置、大小、大体外观、黏膜下浸润深度、淋巴管浸润和组织学分级。根据黏膜下浸润深度将病变细分：sm1，黏膜下浸润至距黏膜肌层500微米以内；sm2，黏膜下浸润在500至1000微米之间；sm3，黏膜下浸润超过1000微米。
总体淋巴结转移率为6.3%（301例中的19例）。黏膜下浸润深度（sm3）和淋巴管浸润的存在在单因素和多因素分析中均为淋巴结转移的显著危险因素。
本研究结果表明，淋巴结转移的显著危险因素是黏膜下浸润程度（sm3）和淋巴管浸润的存在。存在不良因素的患者需要进行手术。
