结直肠 T1 癌内镜黏膜下剥离术后行免疫组化淋巴管评估以决定追加手术的临床意义。
Clinical significance of immunohistochemical lymphovascular evaluation to determine additional surgery after endoscopic submucosal dissection for colorectal T1 carcinoma.
机构信息
Department of Gastroenterology and Metabolism, Hiroshima University Hospital, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan.
出版信息
Int J Colorectal Dis. 2021 May;36(5):949-958. doi: 10.1007/s00384-020-03795-5. Epub 2020 Nov 4.
PURPOSE
The Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines indicate lymphovascular invasion-evaluated by hematoxylin and eosin (HE) staining-as a surgical requirement after endoscopic submucosal dissection (ESD) in T1 colorectal carcinoma (CRC) patients; however, immunohistochemical evaluation may be superior. This study aimed to clarify the significance of immunohistochemical lymphovascular evaluation as an indicator for additional surgery of T1 CRC after ESD, and assessed the guidelines' adequacy, even when evaluating through immunostaining.
METHODS
Patients with T1 CRC who underwent ESD were enrolled across three institutions between January 2012 and December 2017. Immunohistochemical lymphovascular evaluation was performed. Clinicopathological features, pathological evaluations, and surgery indications were recorded. Univariate and multivariate logistic regression identified risk factors for lymph node (LN) metastasis of T1 CRC after ESD.
RESULTS
Among 370 patients with T1 CRC, recurrence, 5-year overall survival, and 5-year disease specific survival rates were 1.6%, 94.6%, and 99.5%, respectively. Six patients (1.6%) experienced recurrence, five of whom underwent additional surgery. Those with no risk factors did not exhibit recurrence. A total of 215 (58.1%) patients underwent additional surgery after ESD, 21 (9.7%) of whom exhibited LN metastasis. Among 16 patients who underwent additional surgery due to lymphovascular invasion, three (18.8%) had LN metastasis. Multivariate logistic regression analysis identified lymphatic invasion as a significant risk factor for LN metastasis (odds ratio 3.9, 95% confidence interval 1.0-14.6, P = 0.0421).
CONCLUSIONS
The JSCCR guidelines have clinical validity, and immunohistochemical lymphatic evaluation findings potentially predict LN metastasis for T1 CRC after ESD.
目的
日本结直肠癌学会（JSCCR）指南指出，在接受内镜黏膜下剥离术（ESD）治疗的 T1 结直肠癌（CRC）患者中，需要通过苏木精和伊红（HE）染色评估淋巴管浸润作为手术要求；然而，免疫组织化学评估可能更优越。本研究旨在阐明免疫组化淋巴管评估作为 T1 CRC 患者 ESD 后额外手术的指标的意义，并评估该指南的充分性，即使通过免疫染色进行评估也是如此。
方法
在 2012 年 1 月至 2017 年 12 月期间，在三家机构招募了接受 ESD 治疗的 T1 CRC 患者。进行了免疫组化淋巴管评估。记录了临床病理特征、病理评估和手术指征。单因素和多因素逻辑回归确定了 T1 CRC 患者 ESD 后发生淋巴结（LN）转移的危险因素。
结果
在 370 例 T1 CRC 患者中，复发、5 年总生存率和 5 年疾病特异性生存率分别为 1.6%、94.6%和 99.5%。6 例（1.6%）患者出现复发，其中 5 例患者接受了额外手术。无危险因素的患者未出现复发。共有 215 例（58.1%）患者在 ESD 后接受了额外手术，其中 21 例（9.7%）患者发生 LN 转移。在因淋巴管侵犯而接受额外手术的 16 例患者中，有 3 例（18.8%）发生 LN 转移。多因素逻辑回归分析发现，淋巴管侵犯是 LN 转移的显著危险因素（比值比 3.9，95%置信区间 1.0-14.6，P = 0.0421）。
结论
JSCCR 指南具有临床有效性，免疫组化淋巴管评估结果可能预测 T1 CRC 患者 ESD 后的 LN 转移。
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