Talbot I C, Ritchie S, Leighton M H, Hughes A O, Bussey H J, Morson B C
Br J Surg. 1980 Jun;67(6):439-42. doi: 10.1002/bjs.1800670619.
A histopathological study of 703 surgical specimens from patients with adenocarcinoma of the rectum revealed invasion of veins by primary growth in almost 52 per cent. Follow-up studies on the patients showed that the corrected 5-year survival rate was significantly worse and liver metastases developed more frequently when venous invasion was present. Invasion of extramural veins was particularly significant whereas spread confined to intramural veins was less important. Invasion of large (thick-walled) veins was of greater consequence than invasion of small (thin-walled) veins and spread into thick-walled extramural veins had the greatest adverse influence of all. Venous spread of tumour takes place in parallel with local spread as measured by the Dukes' stage but exerts an influence on prognosis independent of the Dukes' stage. Similarly, vein invasion parallels the number of lymph node metastases but appears to exert an independent influence on prognosis. Observation of venous spread provides a precise assessment of the likely behaviour of rectal carcinoma and supplements, but does not replace indices such as the Dukes' stage or the number of lymph node metastases in routine use. The implications for surgical technique and management are discussed.
一项对703例直肠癌患者手术标本的组织病理学研究显示，近52%的患者原发性肿瘤存在静脉侵犯。对这些患者的随访研究表明，当存在静脉侵犯时，校正后的5年生存率显著降低，肝转移的发生更为频繁。壁外静脉侵犯尤为显著，而局限于壁内静脉的扩散则相对不那么重要。大（厚壁）静脉侵犯比小（薄壁）静脉侵犯后果更严重，扩散至厚壁壁外静脉的影响最为不利。肿瘤的静脉扩散与根据Dukes分期衡量的局部扩散同时发生，但对预后的影响独立于Dukes分期。同样，静脉侵犯与淋巴结转移数量平行，但似乎对预后有独立影响。观察静脉扩散可为直肠癌的可能行为提供精确评估，它是一种补充，但不能取代常规使用的Dukes分期或淋巴结转移数量等指标。文中还讨论了其对外科技术和治疗的意义。
