Zhou X Y, Ding K F, Li J
Department of Colorectal Surgery and Oncology,Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Key Laboratory of Molecular Biology in Medical Sciences, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310058, China Zhejiang Provincial Clinical Research Center for Cancer, Hangzhou 310058, China Cancer Center of Zhejiang University, Hangzhou 310058, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2023 May 25;26(5):492-498. doi: 10.3760/cma.j.cn441530-20220819-00351.
Early colorectal cancers refer to invasive cancers that have infiltrated into the submucosa without invading muscularis propria, and approximately 10% of these patients have lymph node metastases that cannot be detected by conventional imaging. According to the guidelines of Chinese Society of Clinical Oncology (CSCO) Colorectal Cancer, early colorectal cancer cases with risk factors for lymph node metastasis (poor tumor differentiation, lymphovascular invasion, deep submucosal invasion and high-grade tumor budding) should receive salvage radical surgical resection; however, the specificity of this risk-stratification is inadequate, making most patients undergo unnecessary surgery. Firstly, this review focuses on the definition, oncological impact importance and controversy of the above "risk factors". Then, we introduce the progress of the risk stratification system for lymph node metastasis in early colorectal cancer, including the identification of new pathological risk factors, the construction of new risk quantitative models based on pathological risk factors, artificial intelligence and machine learning technology and the discovery of novel molecular markers associated with lymph node metastasis based on gene test or liquid biopsy. Aim to enhance clinicians' understanding of the risk assessment of lymph node metastasis in early colorectal cancer; we suggest to take the patient's personal situation, tumor location, anti-cancer intention and other factors into account to make individualized treatment strategies.
早期结直肠癌是指已浸润至黏膜下层但未侵犯固有肌层的浸润性癌，这些患者中约10%存在常规影像学检查无法检测到的淋巴结转移。根据中国临床肿瘤学会（CSCO）结直肠癌诊疗指南，具有淋巴结转移风险因素（肿瘤分化差、脉管侵犯、黏膜下层深层浸润和高级别肿瘤芽生）的早期结直肠癌病例应接受挽救性根治性手术切除；然而，这种风险分层的特异性不足，导致大多数患者接受了不必要的手术。首先，本综述聚焦于上述“风险因素”的定义、肿瘤学影响、重要性及争议。然后，我们介绍早期结直肠癌淋巴结转移风险分层系统的进展，包括新病理风险因素的识别、基于病理风险因素构建新的风险定量模型、人工智能和机器学习技术以及基于基因检测或液体活检发现与淋巴结转移相关的新型分子标志物。旨在提高临床医生对早期结直肠癌淋巴结转移风险评估的认识；我们建议综合考虑患者个人情况、肿瘤位置、抗癌意愿等因素制定个体化治疗策略。
