Budding as a risk factor for lymph node metastasis in pTl or pT2 well-differentiated colorectal adenocarcinoma
Budding as a risk factor for lymph node metastasis in pTl or pT2 well-differentiated colorectal adenocarcinoma
复制标题
DOI：
10.1007/s10350-004-6259-0
复制
发表时间：
2002-05-01
影响因子：
3.9
通讯作者：
Ishikawa, I
中科院分区：
文献类型：
--
作者：
Okuyama, T;Oya, M;Ishikawa, I
目的：淋巴结转移是 pT1 和 pT2 结直肠腺癌肿瘤分期和预后的重要指标。淋巴血管侵袭是淋巴结转移的既定危险因素，而据报道，肿瘤侵袭前沿的出芽也与淋巴结转移相关。我们检查了淋巴管侵袭和出芽的共存是否比单独的淋巴管侵袭提供了更好的信息来预测 pT1 或 pT2 高分化结直肠腺癌的淋巴结转移。方法：对手术切除的 101 例 pT1 或 pT2 高分化结直肠腺癌标本进行研究。使用用苏木精肌红染色的切片，我们根据莫罗多米的定义检查了淋巴管侵袭和出芽。结果：39 个病灶（38%）存在淋巴血管侵犯，42 个病灶（41%）出现出芽。在 pT2 肿瘤中比在 pT1 肿瘤中更频繁地检测到出芽。出芽的存在与淋巴管侵犯显着相关。单独的淋巴管侵犯对淋巴结转移的敏感性、特异性、阳性预测值和阴性预测值分别为 79%、76%、34%、96%，而淋巴管侵犯和出芽相结合（无论是淋巴管侵犯还是出芽）的敏感性、特异性、阳性预测值和阴性预测值分别为 93%、52%、24% 和 98%。结论;由于既无淋巴结转移也无出芽的 pT1 或 pT2 高分化结直肠腺癌中淋巴结转移的风险非常低，因此出芽与淋巴血管侵犯的结合似乎是预测淋巴结转移的简单且廉价的病理标志物。因此，pT1或pT2高分化结直肠腺癌的常规病理诊断应检查有无出芽。
PURPOSE: Lymph node metastasis is an important indicator of tumor stage and prognosis in pT1 and pT2 colorectal adenocarcinomas. Lymphovascular invasion is an established risk factor of lymph node metastasis, whereas budding at the invasive front of tumors is also reported to correlate with lymph node metastasis. We examined whether the coexistence of lymphovascular invasion and budding provides any better information than lymphovaseular invasion alone in the prediction of lymph node metastasis of pT1 or pT2 well-differentiated colorectal adenocarcinomas. METHODS: Surgically resected specimens of 101 pT1 or pT2 well-differentiated colorectal adenocarcinomas were studied. Using sections stained with hematoxylineosin, we examined lymphovascular invasion and budding according to Morodomi's definition. RESULTS: Lymphovascular invasion was present in 39 lesions (38 percent), whereas budding was found in 42 lesions (41 percent). Budding was more frequently detected in pT2 tumors than in pT1 tumors. The presence of budding significantly correlated with lymphovascular invasion. Sensitivity, specificity, positive predictive value, and negative predictive value of lymphovascular invasion alone for lymph node metastasis were 79, 76, 34, acid 96 percent, respectively, whereas those of the combination of lymphovascular invasion and budding (either lymphovascular invasion or budding) were 93, 52, 24, and 98 percent, respectively. CONCLUSION; Because the risk of lymph node metastasis in pT1 or pT2 well-differentiated colorectal adenocarcinomas having neither lymph node metastasis nor budding is very low, budding in combination with lymphovascular invasion seems to be a simple and inexpensive pathologic marker in predicting lymph node metastasis. Therefore, the presence or absence of budding should be examined in the routine pathologic diagnosis of pT1 or pT2 well-differentiated colorectal adenocarcinomas.