Tominaga Kenji, Nakanishi Yukihiro, Nimura Satoshi, Yoshimura Kimio, Sakai Yoshihiro, Shimoda Tadakazu
Clinical Laboratory Division, National Cancer Center Hospital, Tokyo, Japan.
Dis Colon Rectum. 2005 Jan;48(1):92-100. doi: 10.1007/s10350-004-0751-4.
Risk factors for lymph node metastasis in patients with nonpedunculated submucosal invasive colorectal carcinoma remain to be characterized. This study examines the relationship between lymph node metastasis and clinicopathologic factors in nonpedunculated submucosal invasive colorectal carcinoma.
The study cohort comprised 155 patients who had undergone surgical treatment for nonpedunculated submucosal invasive colorectal carcinoma. The clinicopathologic factors investigated included gender, age, tumor location, macroscopic type, tumor size, histologic type and grade, intramucosal growth pattern, lymphatic invasion, venous invasion, degree of focal dedifferentiation at the submucosal invasive front, status of the remaining muscularis mucosa, and the depth and width of submucosal invasion.
Lymph node metastases were found in 19 patients (12.3 percent). Univariate analysis showed that lymphatic invasion, focal dedifferentiation at the submucosal invasive front, status of the remaining muscularis mucosa, and depth of submucosal invasion all had a significant influence on lymph node metastasis. Multivariate analysis showed lymphatic invasion (P = 0.014) and high-grade focal dedifferentiation at the submucosal invasive front (P = 0.049) to be independent factors predicting lymph node metastasis. No lymph node metastasis was found in tumors with a depth of submucosal invasion of <1.3 mm.
Lymphatic invasion and high-grade focal dedifferentiation at the submucosal invasive front are important predictors of lymph node metastasis in patients with nonpedunculated submucosal invasive colorectal carcinoma. Depth of submucosal invasion can be used as an identifying marker for patients who do not require subsequent surgery after endoscopic resection.
无蒂黏膜下浸润性结直肠癌患者发生淋巴结转移的危险因素仍有待明确。本研究探讨无蒂黏膜下浸润性结直肠癌患者淋巴结转移与临床病理因素之间的关系。
研究队列包括155例行无蒂黏膜下浸润性结直肠癌手术治疗的患者。所调查的临床病理因素包括性别、年龄、肿瘤位置、大体类型、肿瘤大小、组织学类型和分级、黏膜内生长模式、淋巴血管浸润、黏膜下浸润前沿局灶性去分化程度、剩余黏膜肌层状态以及黏膜下浸润的深度和宽度。
19例患者（12.3%）发生淋巴结转移。单因素分析显示，淋巴血管浸润、黏膜下浸润前沿局灶性去分化、剩余黏膜肌层状态以及黏膜下浸润深度均对淋巴结转移有显著影响。多因素分析显示，淋巴血管浸润（P = 0.014）和黏膜下浸润前沿高级别局灶性去分化（P = 0.049）是预测淋巴结转移的独立因素。黏膜下浸润深度<1.3 mm的肿瘤未发现淋巴结转移。
淋巴血管浸润和黏膜下浸润前沿高级别局灶性去分化是无蒂黏膜下浸润性结直肠癌患者淋巴结转移的重要预测因素。黏膜下浸润深度可作为内镜切除后无需后续手术患者的识别标志物。
