Kaneko Iwao, Tanaka Shinji, Oka Shiro, Kawamura Toru, Hiyama Toru, Ito Masanori, Yoshihara Masaharu, Shimamoto Fumio, Chayama Kazuaki
Department of Medicine and Molecular Science, Hiroshima University Graduate School of Biomedical Science, Hiroshima, Japan.
Dis Colon Rectum. 2007 Jan;50(1):13-21. doi: 10.1007/s10350-006-0745-5.
Lymph node metastasis is an important factor that influences curability after endoscopic treatment of submucosal colorectal cancer. This study was designed to determine the usefulness of identification of lymphatic vessels by immunohistochemistry in predicting lymph node metastasis of submucosal colorectal cancer.
Lymphatic involvement was assessed by hematoxylin and eosin staining and podoplanin immunostaining on samples resected from 268 patients with submucosal colorectal cancer. Lymphatic vessel density was estimated by two investigators by average count of three fields (x200) in the area of greatest number of podoplanin-positive capillaries at the site of deepest submucosal penetration. Relations with other clinicopathologic parameters also were investigated.
Lesions with high lymphatic vessel density (> or =9 vessels per field) showed a significantly greater incidence of lymph node metastasis than did those with low lymphatic vessel density (<9 vessels per field; 23.3 vs. 8.4 percent). By multivariate analysis, lymphatic vessel density was determined to be an independent risk factor for lymph node metastasis of submucosal colorectal cancer (P = 0.0044). Lymphatic vessel density also correlated with tumor budding and the degree of inflammation at the invasive front.
Identification of lymphatic vessels by podoplanin immunostaining provides objective and accurate evaluation of lymphatic involvement. Lymphatic vessel density at the site of deepest penetration is a useful predictor of lymph node metastasis of submucosal colorectal cancer.
淋巴结转移是影响结直肠黏膜下癌内镜治疗后治愈率的重要因素。本研究旨在确定通过免疫组织化学鉴定淋巴管在预测结直肠黏膜下癌淋巴结转移中的作用。
对268例结直肠黏膜下癌患者切除的样本进行苏木精-伊红染色和血小板内皮细胞黏附分子免疫染色，评估淋巴管受累情况。由两名研究人员通过在黏膜下最深浸润部位血小板内皮细胞黏附分子阳性毛细血管数量最多的区域平均计数三个视野（×200）来估计淋巴管密度。还研究了其与其他临床病理参数的关系。
淋巴管密度高（≥9个/视野）的病变淋巴结转移发生率显著高于淋巴管密度低（<9个/视野）的病变（23.3%对8.4%）。多因素分析显示，淋巴管密度是结直肠黏膜下癌淋巴结转移的独立危险因素（P = 0.0044）。淋巴管密度还与肿瘤芽生及浸润前沿的炎症程度相关。
通过血小板内皮细胞黏附分子免疫染色鉴定淋巴管可提供客观准确的淋巴管受累评估。最深浸润部位的淋巴管密度是结直肠黏膜下癌淋巴结转移的有用预测指标。
