高分化腺癌作为T1期结直肠癌淋巴结转移和复发的一个安全因素
Pure Well-differentiated Adenocarcinoma as a Safe Factor for Lymph Node Metastasis and Recurrence of T1 Colorectal Cancer.
作者信息
Inoue Ken, Yoshida Naohisa, Kobayashi Reo, Hirose Ryohei, Iwai Naoto, Dohi Osamu, Murakami Takaaki, Inada Yutaka, Arita Tomohiro, Morinaga Yukiko, Konishi Eiichi, Itoh Yoshito
机构信息
Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Department of Infectious Disease, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
出版信息
J Anus Rectum Colon. 2025 Jul 25;9(3):302-309. doi: 10.23922/jarc.2024-105. eCollection 2025.
OBJECTIVES
Pure well-differentiated adenocarcinoma (PWDA) could be a safe factor against lymph node metastasis (LNM) and recurrence in patients with T1 colorectal cancer. We investigated the utility and endoscopic features of PWDA to determine its predictive ability.
METHODS
We analyzed the LNM and recurrence rates, along with various clinicopathological factors, including PWDA, in 315 patients with T1 colorectal cancer who underwent surgical resection at our center. PWDA was defined as a lesion consisting of well-differentiated adenocarcinoma only. Three pathologists evaluated the consistency of the PWDA diagnosis and performed inter- and intraobserver assessments of PWDA and lymphatic invasion. Endoscopic features of PWDA was also examined.
RESULTS
The LNM, recurrence, and PWDA rates in patients with T1 colorectal cancer were 9.5%, 2.9%, and 31.1%, respectively. Significant differences were observed in T1b (100% vs. 82.8%; p = 0.014) and non-PWDA (100% vs. 65.6%; p < 0.001) between patients with and without LNM. Multivariate analyses showed that non-PWDA was an independent risk factor for LNM (odds ratio [OR], 12.09; 95% confidence interval [CI], 1.59-92.0; p = 0.016). Furthermore, significant differences in venous invasion (44.4% vs. 19.6%; p < 0.001), and non-PWDA (100% vs. 68.0%; p < 0.001) were observed between patients with and without recurrence. The agreement among three pathologists on the diagnosis of PWDA was acceptable (kappa value > 0.5). Surface redness (p < 0.001), a rugged surface (p < 0.01), fold convergence (p < 0.001), and an impression of fullness (p = 0.031) were significantly related with PWDA.
CONCLUSIONS
PWDA can predict safety against LNM and recurrence in patients with T1 colorectal cancer.
目的
在T1期结直肠癌患者中，纯高分化腺癌（PWDA）可能是预防淋巴结转移（LNM）和复发的一个安全因素。我们研究了PWDA的实用性和内镜特征，以确定其预测能力。
方法
我们分析了在本中心接受手术切除的315例T1期结直肠癌患者的LNM和复发率，以及包括PWDA在内的各种临床病理因素。PWDA被定义为仅由高分化腺癌组成的病变。三名病理学家评估了PWDA诊断的一致性，并对PWDA和淋巴管侵犯进行了观察者间和观察者内评估。还检查了PWDA的内镜特征。
结果
T1期结直肠癌患者的LNM、复发和PWDA发生率分别为9.5%、2.9%和31.1%。有和无LNM的患者在T1b（100%对82.8%；p = 0.014）和非PWDA（100%对65.6%；p < 0.001）方面存在显著差异。多因素分析显示，非PWDA是LNM的独立危险因素（比值比[OR]，12.09；95%置信区间[CI]，1.59 - 92.0；p = 0.016）。此外，有和无复发的患者在静脉侵犯（44.4%对19.6%；p < 0.001）和非PWDA（100%对68.0%；p < 0.001）方面存在显著差异。三名病理学家对PWDA诊断的一致性是可接受的（kappa值> 0.5）。表面发红（p < 0.001）、表面粗糙（p < 0.01）、皱襞融合（p < 0.001）和饱满感（p = 0.031）与PWDA显著相关。
结论
PWDA可预测T1期结直肠癌患者LNM和复发的安全性。
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