Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan.
Dig Endosc. 2013 May;25 Suppl 2:21-5. doi: 10.1111/den.12089.
In the 2010 guidelines for the treatment of colorectal cancer from the Japanese Society for Cancer of the Colon and Rectum (JSCCR), the criteria for identifying curable submucosal invasive colorectal carcinoma after endoscopic resection is as follows: differentiated adenocarcinoma, no vascular invasion, submucosal invasion depth <1000 μm and budding grade 1 (low grade). A total of 118 rectal submucosal carcinomas, treated by primary surgical resection or additional surgical resection with lymph node (LN) dissection, were analyzed. Relationships between clinicopathological findings and LN metastasis were evaluated. LN metastasis was found in 11.0% (13/118). There were no significant differences between clinicopathological findings and LN metastasis except for budding grade. Multivariate logistic regression analysis showed budding grade 2/3 (high grade) to be the independent risk factor for LN metastasis. When cases that met the curative condition of histological grade, tumor budding grade and vessel invasion together according to JSCCR 2010 criteria, the incidence of LN metastasis was only 2.2% (1/46, 95% confidence interval: 0.06-11.5%), regardless of the degree of submucosal invasion depth. In conclusion, even in cases of rectal carcinoma with submucosal deep invasion, the risk of LN metastasis is minimal under certain conditions.
在日本结直肠肿瘤学会（JSCCR）2010 年发布的结直肠癌治疗指南中，内镜下切除术后可识别的具有治愈性的黏膜下浸润性结直肠癌的标准如下：分化型腺癌、无血管浸润、黏膜下浸润深度<1000μm 和芽生分级 1（低级别）。本研究共分析了 118 例接受直肠黏膜下癌原发手术切除或联合淋巴结（LN）清扫术的患者。评估了临床病理特征与 LN 转移的关系。发现 11.0%（13/118）的患者发生了 LN 转移。除芽生分级外，其他临床病理特征与 LN 转移均无显著差异。多因素 logistic 回归分析显示芽生分级 2/3（高级别）是 LN 转移的独立危险因素。当根据 JSCCR 2010 标准同时满足组织学分级、肿瘤芽生分级和脉管侵犯的治愈条件时，LN 转移的发生率仅为 2.2%（1/46，95%置信区间：0.06-11.5%），无论黏膜下浸润深度如何。总之，即使在黏膜下深层浸润的直肠癌患者中，在某些条件下，发生 LN 转移的风险也很小。
