Myung Dae-Seong, Kweon Sun-Seog, Lee Jun, Shin Ik-Sang, Kim Sang-Wook, Seo Geom-Seog, Kim Hyun-Soo, Joo Young-Eun
Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
Department of Preventive Medicine, Chonnam National University Medical School, Gwangju, Korea.
PLoS One. 2017 Oct 4;12(10):e0184205. doi: 10.1371/journal.pone.0184205. eCollection 2017.
Laterally spreading colorectal tumors (LSTs) are divided into four subtypes, including homogenous (HG), nodular mixed (NM), flat elevated (FE), and pseudo-depressed (PD), based on their different endoscopic morphologies. The aim of this study was to investigate the clinicopathological significance of LST subtypes and their association with advanced histology.
We investigated the medical records of consecutive patients with LST who initially underwent endoscopic resection at five university hospitals in Honam province of South Korea between January 2012 and December 2013. A total of 566LST lesions removed via endoscopic procedures were collected retrospectively for data analysis.
The PD, FE, and NM subtypes were more common in the distal colon and the HG subtype in the proximal colon. The PD subtype had the biggest tumor size, followed by the NM subtype. The frequency of adenomatous pit pattern was significantly higher in the HG, NM, and FE subtypes than in the PD subtype. In contrast, the frequency of cancerous pit pattern was significantly higher in the PD subtype than in the other three subtypes. The rate of advanced histology (high-grade dysplasia or carcinoma) among the LSTs was 36.0%. The risk of advanced histology increased in the distal colon compared with the proximal colon. The PD subtype had the highest incidence of villous component, advanced histology,submucosal invasion, and postprocedure perforation among the four subtypes. The distal colon as tumor site, larger tumor size, PD subtype, and villous component were associated with a statistically significant increased risk of advanced histology.
Our results indicate that the location, size, endoscopic subtype, and histologic component of the LSTs are associated with an increased risk of advanced histology. Therefore, these clinicopathological parameters may be useful in selecting therapeutic strategies in the clinical setting.
侧向发育型结直肠肿瘤（LST）根据其不同的内镜形态分为四种亚型，包括均匀型（HG）、结节混合型（NM）、扁平隆起型（FE）和假凹陷型（PD）。本研究的目的是探讨LST亚型的临床病理意义及其与高级别组织学的关系。
我们调查了2012年1月至2013年12月期间在韩国湖南地区五所大学医院最初接受内镜切除的连续LST患者的病历。回顾性收集通过内镜手术切除的566个LST病变进行数据分析。
PD、FE和NM亚型在结肠远端更常见，HG亚型在结肠近端更常见。PD亚型的肿瘤最大，其次是NM亚型。HG、NM和FE亚型的腺瘤样凹陷模式频率显著高于PD亚型。相反，PD亚型的癌样凹陷模式频率显著高于其他三种亚型。LST中高级别组织学（高级别异型增生或癌）的发生率为36.0%。与结肠近端相比，结肠远端高级别组织学的风险增加。在四种亚型中，PD亚型的绒毛成分、高级别组织学、黏膜下侵犯和术后穿孔的发生率最高。肿瘤位于结肠远端、肿瘤较大、PD亚型和绒毛成分与高级别组织学的统计学显著增加风险相关。
我们的结果表明，LST的位置、大小、内镜亚型和组织学成分与高级别组织学风险增加有关。因此，这些临床病理参数可能有助于在临床环境中选择治疗策略。
