直肠癌中转移性直肠系膜淋巴结的形态学标准。

Matsuoka Hiroyoshi, Masaki Tadahiko, Kobayashi Takaaki, Sato Kazunori, Sugiyama Masanori, Atomi Yutaka, Ohkura Yasuo

Department of Surgery and Pathology, Kyorin University, School of Medicine, Tokyo, Japan.

Hepatogastroenterology. 2009 Nov-Dec;56(96):1661-4.

BACKGROUND/AIMS: Preoperative diagnostic criteria for mesorectal lymph node metastasis in rectal cancer patients were not consistent in previous reports. This study was conducted to get conclusions on this controversial issue by detailed histological examination.

METHODOLOGY

Fifty-eight patients with rectal carcinoma who underwent total mesorectal excision were studied. The total number of lymph nodes evaluated was 538. Parameters of lymph nodes evaluated were size, shape and texture of internal structure. Size was evaluated using long and short axis diameter. Shape was categorized into ovoid or irregular. Heterogeneity of internal structure was categorized into 4 groups (none, less than half, half or over, and whole) according to the tumor volume in the lymph node.

RESULTS

Of 538 lymph nodes, 118 lymph nodes were found to have metastasis. There was a significant difference in terms of long (6.6 vs. 3.5 mm: p < 0.05) and short axis diameters (5.1 vs. 2.6 mm: p < 0.05) between metastatic and non-metastatic lymph nodes. Shape showed significantly higher proportion of irregularity (26% vs. 11%) in the metastasis group, while ovoid shape was still the majority in both groups. Heterogeneity of internal structure was significantly more frequent in the metastasis group. In the ROC curve analysis, heterogeneity of internal structure showed the highest diagnostic accuracy (Area under ROC curve, AUC: 0.998), followed by long axis diameter (AUC: 0.794), short axis diameter (AUC: 0.821) and shape of lymph nodes (AUC: 0.570). Multivariate analysis showed that presence of heterogeneity (odds ratio 1.442, p < 0.00001), long axis diameter (odds ratio 1.082, p = 0.001) and short axis diameter (odds ratio 1.068, p = 0.037) were the independent signs of lymph node metastasis.

CONCLUSION

The current histological study confirmed that presence of heterogeneity of internal structure, long axis diameter, and short axis diameter were the independent findings for mesorectal lympnode metastasis in rectal cancer patient.

背景/目的：既往报道中直肠癌患者直肠系膜淋巴结转移的术前诊断标准并不一致。本研究通过详细的组织学检查，就这一有争议的问题得出结论。

方法

对58例行全直肠系膜切除术的直肠癌患者进行研究。评估的淋巴结总数为538个。评估淋巴结的参数包括大小、形状和内部结构质地。大小通过长短径进行评估。形状分为卵圆形或不规则形。内部结构的异质性根据淋巴结内肿瘤体积分为4组（无、小于一半、一半或以上、全部）。

结果

在538个淋巴结中，发现118个淋巴结有转移。转移淋巴结与非转移淋巴结在长径（6.6 vs. 3.5 mm：p < 0.05）和短径（5.1 vs. 2.6 mm：p < 0.05）方面存在显著差异。形状方面，转移组中不规则形的比例显著更高（26% vs. 11%），而两组中卵圆形仍占多数。转移组中内部结构的异质性更为常见。在ROC曲线分析中，内部结构异质性的诊断准确性最高（ROC曲线下面积，AUC：0.998），其次是长径（AUC：0.794）、短径（AUC：0.821）和淋巴结形状（AUC：0.570）。多因素分析显示，异质性的存在（比值比1.442，p < 0.00001）、长径（比值比1.082，p = 0.001）和短径（比值比1.068，p = 0.037）是淋巴结转移的独立征象。