Yamamoto Y, Takahashi K, Yasuno M, Sakoma T, Mori T
Department of Surgery, Tokyo Metropolitan Komagome Hospital, Japan.
Jpn J Clin Oncol. 1998 Jun;28(6):378-82. doi: 10.1093/jjco/28.6.378.
We have sometimes experienced cases of colorectal cancer with skipping lymph node metastasis in which distant nodes were positive but those closer to the tumor were negative. There have been few reports of this condition and its clinical characteristics have not been clarified. This study was conducted to clarify the status of skipping lymph node metastasis and its clinicopathological characteristics in colorectal cancer.
We analyzed 452 patients with colorectal cancer and nodal metastases (270 with colon cancer and 182 with rectal cancer). All the resected nodes were examined using histological procedures with a microscope and were classified by their location according to the General Rules for Clinical and Pathological Studies on Cancer of the Colon, Rectum and Anus. We studied the status of skipping nodal status and the correlation between the nodal status and clinicopathological findings, including the disease-free survival, depth of tumor, histological type, staging and recurrence.
Twenty-eight (10.4%) of the colon cancer patients and 20 (11.0%) of the rectal cancer patients were found to have skipping nodal metastases. In rectal cancer patients with n2 (nodal metastases at the N2 site) in the direction of the main node, patients with skipping lymph node metastases had a significantly better prognosis than those without (p = 0.026). In all colon cancer patients and rectal cancer patients with lateral n3 (nodal metastases at the lateral N3 site), there were a tendency for those with skipping nodal metastases to have better disease-free survival rates (p = 0.1). Also, the mean number of positive nodes in skipping cases was significantly lower than that in non-skipping cases. In addition, skipping nodal metastases in rectal cancer suggested a possibility of bypass flow which was not generally recognized.
These findings in colorectal cancer suggest the presence of previously unknown lymphatic tracts and that the cancers concerned have a better prognosis than those without skipping nodal metastases.
我们有时会遇到结直肠癌出现跳跃性淋巴结转移的病例，即远处淋巴结呈阳性，而距离肿瘤较近的淋巴结为阴性。关于这种情况的报道很少，其临床特征也尚未明确。本研究旨在阐明结直肠癌跳跃性淋巴结转移的状况及其临床病理特征。
我们分析了452例伴有淋巴结转移的结直肠癌患者（270例结肠癌患者和182例直肠癌患者）。所有切除的淋巴结均通过显微镜组织学检查，并根据《结肠、直肠和肛管癌临床与病理研究总则》按其位置进行分类。我们研究了跳跃性淋巴结状态以及淋巴结状态与临床病理结果之间的相关性，包括无病生存期、肿瘤深度、组织学类型、分期和复发情况。
发现28例（10.4%）结肠癌患者和20例（11.0%）直肠癌患者存在跳跃性淋巴结转移。在直肠癌患者中，在主淋巴结方向出现n2（N2部位淋巴结转移）时，有跳跃性淋巴结转移的患者预后明显优于无跳跃性淋巴结转移的患者（p = 0.026）。在所有结肠癌患者以及出现外侧n3（外侧N3部位淋巴结转移）的直肠癌患者中，有跳跃性淋巴结转移的患者无病生存率有更高的趋势（p = 0.1）。此外，跳跃性病例中的阳性淋巴结平均数量明显低于非跳跃性病例。另外，直肠癌中的跳跃性淋巴结转移提示存在一种通常未被认识到的旁路引流可能性。
结直肠癌的这些发现提示存在以前未知的淋巴途径，并且相关癌症的预后比无跳跃性淋巴结转移的癌症更好。
