Ouchi K, Sugawara T, Ono H, Fujiya T, Kamiyama Y, Kakugawa Y, Mikuni J, Tateno H
Department of Surgery, Miyagi Cancer Center, Natori, Japan.
Cancer. 1996 Dec 1;78(11):2313-7. doi: 10.1002/(sici)1097-0142(19961201)78:11<2313::aid-cncr7>3.0.co;2-n.
In colorectal carcinoma, venous invasion has been related to patient survival. Liver metastasis develops more frequently when venous invasion is present. However, the histologic features and clinical significance of venous invasion are not well understood.
A histologic study of venous invasion in colorectal carcinoma was performed on 19 patients with synchronous hepatic metastasis (Group A), 16 patients with metacaronous hepatic metastasis (Group B), and 26 patients with Dukes Stage C tumors who survived for 5 years without recurrence (Group C). The histologic features of venous invasion were classified into three types: tumor cells that were distant from the vein walls were categorized as floating type, those filling the lumen of a vein as filling type, and those surrounded by a vein obliterated with inflammatory reaction as occlusive type.
Venous invasion was present in 89.5% of Group A patients and 75% of Group B patients, which was significantly higher than the 15.4% observed in Group C patients (P < 0.001). A slight to extensive degree of venous invasion was found in Groups A and B, but no extensive venous invasion was found in Group C. All patients in Groups A and B (except one patient) had floating, filling, or a combination of floating and filling types of venous invasion, whereas all patients in Group C had the occlusive type of venous invasion. A majority of the patients in all three groups showed invasion of extramural veins.
There is a close relationship between venous invasion and the development of liver metastasis in patients with colorectal carcinoma. Patients with no sign of metastasis had a lower incidence and lower extent of venous invasion, and inflammatory damage to the vein walls around the intravenous tumor appeared to reduce the likelihood of distant metastasis.
在结直肠癌中，静脉侵犯与患者生存率相关。存在静脉侵犯时肝转移更常发生。然而，静脉侵犯的组织学特征和临床意义尚未完全明确。
对19例同时性肝转移患者（A组）、16例异时性肝转移患者（B组）和26例存活5年无复发的Dukes C期肿瘤患者（C组）进行了结直肠癌静脉侵犯的组织学研究。静脉侵犯的组织学特征分为三种类型：远离静脉壁的肿瘤细胞归为漂浮型，填充静脉腔的归为填充型，被伴有炎症反应而闭塞的静脉包围的归为闭塞型。
A组89.5%的患者和B组75%的患者存在静脉侵犯，显著高于C组观察到的15.4%（P<0.001）。A组和B组发现了轻度至广泛程度的静脉侵犯，但C组未发现广泛静脉侵犯。A组和B组的所有患者（除1例患者外）均有漂浮型、填充型或漂浮与填充型组合的静脉侵犯，而C组所有患者均为闭塞型静脉侵犯。所有三组中的大多数患者均显示壁外静脉侵犯。
结直肠癌患者的静脉侵犯与肝转移的发生密切相关。无转移迹象的患者静脉侵犯的发生率和程度较低，静脉内肿瘤周围静脉壁的炎性损伤似乎降低了远处转移的可能性。
