Department of Surgery, National Defense Medical College, Saitama
Department of Surgery, National Defense Medical College, Saitama.
Jpn J Clin Oncol. 2014 Jun;44(6):547-55. doi: 10.1093/jjco/hyu043. Epub 2014 May 6.
The actual status of stage migration in colon cancer that occurs in the procedure of preparing pathological specimens of lymph nodes has not been fully investigated.
A nationwide survey of specialist institutions for colon cancer treatment was conducted to clarify interinstitutional differences in processing surgical specimens. After categorizing 111 institutions on the basis of their practice of processing specimens, distribution of tumor stage and the recurrence status of 3294 colon cancer patients treated with the same level of lymphadenectomy were compared.
Patients were diagnosed with lower tumor stages in non-teaching hospitals, in hospitals where lymph nodes were retrieved by less experienced clinicians and in hospitals in which lymph nodes were retrieved with procedures that preserved the planes of surgery around the primary tumor. However, the process of sectioning and embedding lymph nodes did not affect stage distribution. The average number of lymph nodes examined per case in each institute was 19.4. Institutional number of lymph nodes examined was not associated with node positivity but it did affect the substage in Stage III for number of lymph nodes examined ≥21. In contrast, none of the factors associated with stage migration caused interinstitutional differences in the recurrence status according to the tumor stage.
Considerable variety in the processing of surgical specimens existed even within one country, which could be a cause of stage migration in colon cancer. Better awareness of the clinical impact of the lymph node retrieval process is needed; an international guideline to standardize the treatment of surgical specimens might increase the value of tumor staging.
在准备淋巴结病理标本的过程中，结肠癌的实际分期迁移情况尚未得到充分研究。
对专门治疗结肠癌的机构进行了全国范围的调查，以明确手术标本处理方面的机构间差异。在根据标本处理实践对 111 家机构进行分类后，比较了 3294 例接受相同水平淋巴结清扫术的结肠癌患者的肿瘤分期分布和复发情况。
在非教学医院、由经验较少的临床医生检索淋巴结的医院以及在保留原发肿瘤周围手术平面的淋巴结检索过程中，患者被诊断为较低的肿瘤分期。然而，淋巴结的切片和包埋过程并不影响分期分布。每个机构检查的平均淋巴结数量为 19.4 个。机构检查的淋巴结数量与阳性淋巴结无关，但它确实影响了 III 期中检查的淋巴结数量≥21 个的亚分期。相比之下，没有任何因素与分期迁移有关，根据肿瘤分期，这些因素不会导致机构间的复发状态差异。
即使在一个国家内，手术标本的处理也存在相当大的差异，这可能是结肠癌分期迁移的原因之一。需要更好地了解淋巴结检索过程的临床影响；制定标准化手术标本处理的国际指南可能会增加肿瘤分期的价值。
