Department of Pathology, Pusan National University Hospital and Pusan National University School of Medicine, and Biomedical Research Institute, Busan, Korea.
Department of Surgery, Pusan National University Hospital and Pusan National University School of Medicine, and Biomedical Research Institute, Busan, Korea.
Hum Pathol. 2018 Aug;78:8-17. doi: 10.1016/j.humpath.2018.02.001. Epub 2018 Feb 13.
Endoscopic resection is widely recognized as a first-line treatment for T1 colorectal cancers (CRC), although additional surgical intervention may be indicated based on the risk of lymph node (LN) metastasis. However, risk factors for LN metastasis in T1 CRC not fully established. We investigated the clinicopathological features of T1 CRC and evaluated their association with lymph node metastasis in 133 cases of T1 CRC, consisting of 87 cases with first-line endoscopic resection (EMR) followed by additional surgery and 46 cases with primary surgical resection. Among the total 133 cases, 16 cases (12.0%) showed LN metastasis; 13 cases (13/16, 81.25%) were included in endoscopic resection cohort. These were all of the non-pedunculated gross type and most of LN+ tumors invaded submucosa over 1000 μm (surgical cohort versus endoscopic resection cohort; 3 versus 11). However, there was no statistical difference in the depth of submucosal invasion between the LN+ and LN- in both surgical cohort (2799.42 μm ± 401.56 versus 3000.00 μm ± 721.69, P = .897) and endoscopic resection cohort (2066.55 μm ± 142.96 versus 2305.77 μm ± 345.62, P = .520). Conversely, presence of and a higher number of tumor budding foci were associated with an increase in the incidence of LN metastasis in both cohort (P < .0001). Positive resection margins as well as absence of adenoma component were also an independent predictive factor for lymph node metastasis in 87 cases with first-line endoscopic resection followed by additional surgery. We found that tumor budding was the most reliable LN metastasis predictor in T1 CRC in both surgically resected and endoscopic resection specimens.
内镜下切除被广泛认为是 T1 结直肠癌（CRC）的一线治疗方法，尽管根据淋巴结（LN）转移的风险可能需要额外的手术干预。然而，T1 CRC 中 LN 转移的危险因素尚未完全确定。我们研究了 T1 CRC 的临床病理特征，并评估了它们与 133 例 T1 CRC 中淋巴结转移的关系，其中 87 例患者接受了一线内镜下切除（EMR），然后进行了额外的手术，46 例患者接受了原发性手术切除。在总共 133 例病例中，有 16 例（12.0%）发生淋巴结转移；13 例（13/16，81.25%）被纳入内镜下切除组。这些都是无蒂的大体类型，并且大多数 LN+肿瘤侵犯黏膜下层超过 1000μm（手术组与内镜下切除组；3 例与 11 例）。然而，在手术组（2799.42μm±401.56 与 3000.00μm±721.69，P=.897）和内镜下切除组（2066.55μm±142.96 与 2305.77μm±345.62，P=.520）中，LN+和 LN-之间的黏膜下层浸润深度均无统计学差异。相反，肿瘤芽的存在和数量的增加与两个队列中 LN 转移发生率的增加相关（P<0.0001）。阳性切缘以及无腺瘤成分也是 87 例接受一线内镜下切除加额外手术的患者发生淋巴结转移的独立预测因素。我们发现，在手术和内镜下切除标本中，肿瘤芽是 T1 CRC 中最可靠的淋巴结转移预测因子。
