Pan Wensheng, Terai Takeshi, Abe Satoshi, Sakamoto Naoto, Nagahara Akihito, Ohkusa Toshifumi, Ogihara Tatsuo, Sato Nobuhiro
Department of Gastroenterology, Juntendo University School of Medicine, Bunkyo-ku, Tokyo, Japan.
Dis Colon Rectum. 2006 May;49(5):579-87. doi: 10.1007/s10350-006-0508-3.
This study was designed to look for significant correlations between location of early colorectal cancer, distance from muscularis mucosae to muscularis propria, and the frequency of lymph node metastasis.
A total of 166 early colorectal cancers, including 67 surgically resected lesions, were evaluated. The cancers were divided into two groups: metastatic and nonmetastatic. Cancer lesions were further subtyped at the fold-top or fold-bottom. Macroscopic classifications and histology were performed. Absolute invasive depth and distance from muscularis mucosae to muscularis propria was measured. Multivariate analysis was used to assess relationships among the variables.
The percentage of polypoid cancer lesions at fold-bottom was higher than at fold-top (74.5 vs. 51.8 percent), whereas flat-type cancer lesions at fold-bottom occurred less often than at fold-top (8.2 vs. 30.4 percent). Logistic regression showed that deep absolute invasive depth, lymphatic and vessel invasion, and cancer location (at fold-bottom) were the significant risk factors for early colorectal cancers leading to lymph-node metastasis. The distance from muscularis mucosae to muscularis propria with lymph-node metastasis (1,396.7 +/- 728.4 microm) was shorter than without lymph-node metastasis (3,533.9 +/- 2,507.8 microm; P < 0.01). Multivariate analysis showed that distance from muscularis mucosae to muscularis propria was a statistically significant factor for early colorectal cancers leading to lymph node metastasis (P = 0.0054).
We conclude that early colorectal cancers at the fold-top or with a long distance from muscularis mucosae to muscularis propria have less tendency to metastasize to lymph nodes. Clinically, these results provide evidence of a new indicator of endoscopic mucosal resection for early colorectal cancers at the fold-top.
本研究旨在探寻早期结直肠癌的位置、黏膜肌层至固有肌层的距离与淋巴结转移频率之间的显著相关性。
共评估了166例早期结直肠癌，其中包括67例手术切除的病变。这些癌症被分为两组：转移组和非转移组。癌症病变进一步按皱襞顶部或皱襞底部进行亚型分类。进行了宏观分类和组织学检查。测量了绝对浸润深度以及黏膜肌层至固有肌层的距离。采用多变量分析来评估各变量之间的关系。
皱襞底部息肉样癌病变的百分比高于皱襞顶部（74.5%对51.8%），而皱襞底部扁平型癌病变的发生率低于皱襞顶部（8.2%对30.4%）。逻辑回归显示，绝对浸润深度深、淋巴管和血管侵犯以及癌症位置（在皱襞底部）是早期结直肠癌导致淋巴结转移的显著危险因素。发生淋巴结转移的黏膜肌层至固有肌层的距离（1396.7±728.4微米）短于未发生淋巴结转移的距离（3533.9±2507.8微米；P<0.01）。多变量分析显示，黏膜肌层至固有肌层的距离是早期结直肠癌导致淋巴结转移的一个具有统计学意义的因素（P=0.0054）。
我们得出结论，位于皱襞顶部或黏膜肌层至固有肌层距离较长的早期结直肠癌发生淋巴结转移的倾向较小。临床上，这些结果为皱襞顶部早期结直肠癌的内镜黏膜切除术提供了一个新指标的证据。
