Sitzler P J, Seow-Choen F, Ho Y H, Leong A P
Department of Colorectal Surgery, Singapore General Hospital.
Dis Colon Rectum. 1997 Dec;40(12):1472-6. doi: 10.1007/BF02070714.
Superficial rectal tumors are said to involve regional lymph nodes rarely. This presumption must be proven beyond any doubt if less radical surgery is to be offered for such patients.
Eight hundred five cases (467 males; median age, 64 (range, 19-97) years) of rectal cancer were reviewed.
Lymph node positivity, number of lymph nodes involved, lymphatic vessel, and venous and perineural invasion were significantly increased with increasing depth of invasion of tumor through the bowel wall in univariate analysis. The percentage of lymph node involvement at each tumor depth was as follows: T1, 5.7 percent; T2, 19.6 percent; T3, 65.7 percent; T4, 78.8 percent. Overall lymph node involvement was 59 percent. For patients younger than 45 years of age, the percentage of lymph node involvement was 33.3, 30, 69.3, and 83.3 percent compared with 3.1, 8.4, 64.2, and 78.8 percent for patients aged 45 years or above for T1, T2, T3, and T4, respectively.
Increased depths of tumor penetration beyond T1 and age less than 45 years have an excessive incidence of lymph node positivity. The finding of lymphatic vessel invasion on biopsy is highly indicative of lymph node metastasis.
据说浅表性直肠肿瘤很少累及区域淋巴结。如果要为这类患者提供根治性较低的手术，这一假设必须得到毫无争议的证实。
回顾了805例直肠癌病例（467例男性；中位年龄64岁（范围19 - 97岁））。
在单因素分析中，随着肿瘤通过肠壁浸润深度的增加，淋巴结阳性率、受累淋巴结数量、淋巴管以及静脉和神经周围浸润均显著增加。各肿瘤深度的淋巴结受累百分比分别为：T1期，5.7%；T2期，19.6%；T3期，65.7%；T4期，78.8%。总体淋巴结受累率为59%。对于年龄小于45岁的患者，T1、T2、T3和T4期的淋巴结受累百分比分别为33.3%、30%、69.3%和83.3%，而45岁及以上患者相应分期的淋巴结受累百分比分别为3.1%、8.4%、64.2%和78.8%。
肿瘤浸润深度超过T1期且年龄小于45岁时，淋巴结阳性发生率过高。活检发现淋巴管浸润高度提示淋巴结转移。
