Korita Pavel V, Wakai Toshifumi, Shirai Yoshio, Sakata Jun, Takizawa Kazuyasu, Cruz Pauldion V, Ajioka Yoichi, Hatakeyama Katsuyoshi
Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata City, 951-8510, Japan.
Ann Surg Oncol. 2007 Dec;14(12):3472-80. doi: 10.1245/s10434-007-9594-2. Epub 2007 Sep 8.
D2-40 monoclonal antibody immunoreactivity is specific for lymphatic endothelium and therefore provides a marker of lymphatic invasion. We hypothesized that intrahepatic lymphatic invasion reflects the nodal status of colorectal carcinoma liver metastases and may function as an adverse prognostic factor.
A retrospective analysis of 105 consecutive patients who underwent resection for colorectal carcinoma liver metastases was conducted. Intrahepatic lymphatic invasion was declared when either single tumor cells or cell clusters were clearly visible within vessels that showed immunoreactivity for D2-40 monoclonal antibody. The median follow-up time was 124 months.
Of 105 patients, 13 were classified as having intrahepatic lymphatic invasion. All tumor foci of intrahepatic lymphatic invasion were detected within the portal tracts. Intrahepatic lymphatic invasion was significantly associated with hepatic lymph node involvement (P = 0.039). Survival after resection was significantly worse in patients with intrahepatic lymphatic invasion (median survival time of 13 months; cumulative five-year survival rate of 0%) than in patients without (median survival time of 40 months; cumulative five-year survival rate of 41%; P < 0.0001). Patients with intrahepatic lymphatic invasion also showed decreased disease-free survival rates (P < 0.0001). Intrahepatic lymphatic invasion thus independently affected both survival (relative risk, 7.666; 95% confidence interval, 3.732-15.748; P < 0.001) and disease-free survival (relative risk, 4.112; 95% confidence interval, 2.185-7.738; P < 0.001).
Intrahepatic lymphatic invasion is associated with hepatic lymph node involvement and is an adverse prognostic factor in patients with colorectal carcinoma liver metastases.
D2-40单克隆抗体免疫反应对淋巴管内皮具有特异性，因此可作为淋巴管浸润的标志物。我们推测肝内淋巴管浸润反映了结直肠癌肝转移的淋巴结状态，可能是一个不良预后因素。
对105例连续接受结直肠癌肝转移切除术的患者进行回顾性分析。当在对D2-40单克隆抗体呈免疫反应的血管内清晰可见单个肿瘤细胞或细胞簇时，判定为肝内淋巴管浸润。中位随访时间为124个月。
105例患者中，13例被判定有肝内淋巴管浸润。所有肝内淋巴管浸润的肿瘤灶均在门静脉区域内被检测到。肝内淋巴管浸润与肝淋巴结受累显著相关（P = 0.039）。有肝内淋巴管浸润的患者切除术后生存率显著低于无肝内淋巴管浸润的患者（中位生存时间13个月；累积五年生存率0%）（中位生存时间40个月；累积五年生存率41%；P < 0.0001）。有肝内淋巴管浸润的患者无病生存率也降低（P < 0.0001）。因此，肝内淋巴管浸润独立影响生存率（相对风险，7.666；95%置信区间，3.732 - 15.748；P < 0.001）和无病生存率（相对风险，4.112；95%置信区间，2.185 - 7.738；P < 0.001）。
肝内淋巴管浸润与肝淋巴结受累相关，是结直肠癌肝转移患者的不良预后因素。
