Lymphovascular or Perineural Invasion May Predict Lymph Node Metastasis in Patients With T1 and T2 Colorectal Cancer
Lymphovascular or Perineural Invasion May Predict Lymph Node Metastasis in Patients With T1 and T2 Colorectal Cancer
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DOI：
10.1007/s11605-010-1206-y
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发表时间：
2010-07-01
影响因子：
3.2
通讯作者：
Kim, Young Jin
中科院分区：
文献类型：
--
作者：
Huh, Jung Wook;Kim, Hyeong Rok;Kim, Young Jin
为探讨T1、T2期结直肠癌患者淋巴结转移的预测因素，对1999年1月至2008年1月间收治的224例T1、T2期结直肠癌患者行区域淋巴清扫根治术，分析其淋巴结转移的预测因素和预后因素。肿瘤分期T1期69例(30.8%)，T2期155例(69.2%)。总的淋巴结转移率为21.0%(T1癌14.5%，T2癌23.9%；P=0.112)。淋巴结阳性组和阴性组的患者人口学特征相似，不同之处在于前者的淋巴血管侵犯和神经周围侵犯的病例数明显更高。中位随访期49个月，无淋巴结转移者的5年总生存率和无瘤生存率分别为97.1%和94.6%，显著高于有淋巴结转移者的5年无瘤生存率(85.5%，P=0.008和82.0%，P=0.007)。多因素分析显示，淋巴结状况是影响总生存率(P=0.025)和无瘤生存率(P=0.040)的唯一独立预后因素。此外，淋巴血管侵犯(P<；0.001)或神经周围侵犯(P=0.004)是淋巴结转移的独立预测因素，而淋巴转移是T1或T2结直肠癌患者预后较差的最有力的预测因素。对于淋巴血管或神经侵犯阳性的患者，应推荐根治性手术，因为有更大的机会发生淋巴转移。
The aim of the study was to evaluate factors for predicting lymph node metastasis in patients who had T1 and T2 colorectal cancer.A total of 224 patients with T1 or T2 colorectal cancers who underwent radical surgery with regional lymphadenectomy from January 1999 to January 2008 were analyzed.Predictive factors for lymph node metastasis and prognostic factors were analyzed. Tumor stage was classified as T1 in 69 (30.8%) and T2 in 155 (69.2%) of patients. The overall incidence of lymph node metastasis was 21.0% (14.5% for T1 cancer and 23.9% for T2 cancer; P = 0.112). The node positive and negative groups were similar with regard to patient demographics, except that the former contained a significantly higher number of lymphovascular invasion and perineural invasion cases. During the median follow-up period of 49 months, the 5-year overall and disease-free survival rates for patients without lymph node metastasis were 97.1% and 94.6%, which were significantly higher than the rates for those with lymph node metastasis (85.5%, P = 0.008, and 82.0%, P = 0.007, respectively). A multivariate analysis revealed that lymph node status was the only significant independent prognostic factor for both overall survival (P = 0.025) and disease-free survival (P = 0.040). Moreover, the presence of lymphovascular invasion (P < 0.001) or perineural invasion (P = 0.004) was an independent predictor for lymph node metastasis.Lymph node metastasis was the most powerful predictor for poorer survival in patients with T1 or T2 colorectal cancer. For patients with positive lymphovascular or perineural invasion, radical surgery should be recommended because of a greater chance for lymph node metastasis.