Piao Zhenghua, Ge Rong, Wang Chunnian
Department of Pathology, Ningbo Clinical Pathology Diagnosis Center, Ningbo, 315031, China.
Int J Colorectal Dis. 2023 Jan 26;38(1):25. doi: 10.1007/s00384-023-04319-7.
At present, for patients with early colorectal cancer as long as having any one risk factor of lymph node metastasis (LNM) after endoscopic resection (ER), additional surgery will be considered, regardless of the degree of LNM risk; however, most patients are free of LNM. This study aimed to further grade these patients according to LNM risk.
We assessed 271 patients with T1 colorectal cancers treated initially with ER to analyze the correlation between LNM-associated risk factors and LNM rate. Differences in this rate between groups were estimated using the χ test or Fisher's exact test.
Poorly differentiated adenocarcinoma (Por) (3.4% vs. 40%, p < 0.001) and lymphovascular infiltration (LV) (1.6% vs. 29.0%, p < 0.001) were the only parameters correlated with LNM. When we divided the cases into LV-negative (LV(-)) and LV-positive (LV(+)) groups, we found a significantly higher LNM rate in the LV(+) group (29.0% vs. 1.6%, p < 0.001). Additionally, the rate of LNM in those positive for each parameter did not differ from the control rate in the same group, except in the Por subgroup. When the cases were divided into four groups based on the presence of LV infiltration and Por, the LNM rate in each group was 2/233 cases (0.8%) in the LV(-)Por(-) group, 2/7 cases (28.5%) in the LV(-)Por(+) group, 7/28 cases (25.0%) in the LV(+)Por(-) group, and 2/3 cases (66.6%) in the LV(+)Por(+) group.
Based on LV and histological differentiation, patients were classified into three LNM risk grades: low (LNM, 0.8%), moderate (LNM, 25.0-28.5%), and high (LNM, 66.6%).
目前，对于早期结直肠癌患者，只要在内镜切除（ER）后存在任何一项淋巴结转移（LNM）风险因素，无论LNM风险程度如何，都会考虑进行额外手术；然而，大多数患者不存在LNM。本研究旨在根据LNM风险对这些患者进一步分级。
我们评估了271例最初接受ER治疗的T1期结直肠癌患者，以分析LNM相关风险因素与LNM发生率之间的相关性。使用χ检验或Fisher精确检验估计各组之间该发生率的差异。
低分化腺癌（Por）（3.4%对40%，p<0.001）和淋巴管浸润（LV）（1.6%对29.0%，p<0.001）是与LNM相关的仅有的参数。当我们将病例分为LV阴性（LV(-)）组和LV阳性（LV(+)）组时，我们发现LV(+)组的LNM发生率显著更高（29.0%对1.6%，p<0.001）。此外，除了Por亚组外，各参数阳性患者的LNM发生率与同组对照组发生率无差异。当根据LV浸润和Por的存在将病例分为四组时，LV(-)Por(-)组中每组的LNM发生率为2/233例（0.8%），LV(-)Por(+)组为2/7例（28.5%），LV(+)Por(-)组为7/28例（25.0%），LV(+)Por(+)组为2/3例（66.6%）。
基于LV和组织学分化，患者被分为三个LNM风险等级：低（LNM，0.8%）、中（LNM，25.0 - 28.5%）和高（LNM，66.6%）。
