Dept. of Surgery, National Defense Medical College, Tokorozawa, Saitama, Japan.
Am J Clin Pathol. 2010 Aug;134(2):312-22. doi: 10.1309/AJCPMQ7I5ZTTZSOM.
To establish objective criteria for "grade 3" (G3) in T1 (TNM staging) colorectal cancer (CRC), a total of 296 T1 CRC cases were reviewed. The incidence of nodal involvement differed most greatly between G3 and non-G3 (21/27 [27%] and 6/162 [3.7%], respectively; P < .0001), when G3 was applied to tumors containing either or both of the following: (1) 10 or more solid cancer nests in the microscopic field of a 4x objective lens and (2) a mucin-producing component fully occupied the microscopic field of a 40x objective lens. Regarding G3, vascular invasion, and tumor budding as indicating the risk of metastasis, nodal involvement rate was 21.0% in the tumors with 1 or more risk factors, whereas it was only 1.7% in the no-risk tumors (P < .0001). In patients treated with local excision only, nodal recurrence occurred in 3 (20%) of 15 risk-positive patients, whereas none of 42 patients without risk factors had nodal recurrence (P = .016). In cases of locally excised T1 CRC, G3 as determined by the proposed criteria, vascular invasion, and budding would comprise a useful combination of parameters for determining the indication for additional laparotomy.
为了为 T1（TNM 分期）结直肠癌（CRC）中的“3 级（G3）”建立客观标准，共回顾了 296 例 T1 CRC 病例。当 G3 应用于包含以下任何一种或两种情况的肿瘤时，淋巴结受累的发生率在 G3 和非 G3 之间差异最大：（1）在 4x 物镜的显微镜视野中存在 10 个或更多实性癌巢，以及（2）产生粘蛋白的成分完全占据 40x 物镜的显微镜视野。关于 G3、血管侵犯和肿瘤芽生作为转移风险的指标，在具有 1 个或多个危险因素的肿瘤中，淋巴结受累率为 21.0%，而在无风险肿瘤中仅为 1.7%（P<.0001）。在仅接受局部切除治疗的患者中，15 例风险阳性患者中有 3 例（20%）发生淋巴结复发，而无危险因素的 42 例患者中无一例发生淋巴结复发（P=.016）。对于局部切除的 T1 CRC，由提出的标准确定的 G3、血管侵犯和芽生将成为确定是否需要进一步剖腹手术的有用参数组合。
