Clinical significance of immunohistochemical lymphovascular evaluation to determine additional surgery after endoscopic submucosal dissection for colorectal T1 carcinoma
Clinical significance of immunohistochemical lymphovascular evaluation to determine additional surgery after endoscopic submucosal dissection for colorectal T1 carcinoma
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DOI：
10.1007/s00384-020-03795-5
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发表时间：
2020-11-04
影响因子：
2.8
通讯作者：
Chayama, Kazuaki
中科院分区：
文献类型：
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作者：
Nishimura, Tomoyuki;Oka, Shiro;Chayama, Kazuaki
目的 日本结肠直肠癌协会 (JSCCR) 指南指出，通过苏木精和伊红 (HE) 染色评估淋巴血管侵犯，作为 T1 结直肠癌 (CRC) 患者内镜粘膜下剥离术 (ESD) 后的手术要求；然而，免疫组织化学评估可能更好。本研究旨在阐明免疫组织化学淋巴血管评估作为 ESD 后 T1 CRC 额外手术指标的重要性，并评估指南的充分性，即使通过免疫染色进行评估也是如此。方法 2012 年 1 月至 2017 年 12 月期间，在三个机构招募接受 ESD 的 T1 CRC 患者。进行免疫组织化学淋巴血管评估。记录临床病理特征、病理评估和手术指征。单变量和多变量逻辑回归确定了 ESD 后 T1 CRC 淋巴结 (LN) 转移的危险因素。结果 370 例 T1 CRC 患者中，复发率、5 年总生存率和 5 年疾病特异性生存率分别为 1.6%、94.6% 和 99.5%。六名患者（1.6%）出现复发，其中五名患者接受了额外的手术。那些没有危险因素的人没有表现出复发。共有 215 例（58.1%）患者在 ESD 后接受了额外手术，其中 21 例（9.7%）出现淋巴结转移。 16例因淋巴管侵犯而接受额外手术的患者中，3例（18.8%）出现淋巴结转移。多变量逻辑回归分析确定淋巴管侵犯是淋巴结转移的重要危险因素（比值比 3.9，95% 置信区间 1.0-14.6，P = 0.0421）。结论 JSCCR 指南具有临床有效性，免疫组织化学淋巴评估结果可能预测 ESD 后 T1 CRC 的淋巴结转移。
Purpose The Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines indicate lymphovascular invasion-evaluated by hematoxylin and eosin (HE) staining-as a surgical requirement after endoscopic submucosal dissection (ESD) in T1 colorectal carcinoma (CRC) patients; however, immunohistochemical evaluation may be superior. This study aimed to clarify the significance of immunohistochemical lymphovascular evaluation as an indicator for additional surgery of T1 CRC after ESD, and assessed the guidelines' adequacy, even when evaluating through immunostaining. Methods Patients with T1 CRC who underwent ESD were enrolled across three institutions between January 2012 and December 2017. Immunohistochemical lymphovascular evaluation was performed. Clinicopathological features, pathological evaluations, and surgery indications were recorded. Univariate and multivariate logistic regression identified risk factors for lymph node (LN) metastasis of T1 CRC after ESD. Results Among 370 patients with T1 CRC, recurrence, 5-year overall survival, and 5-year disease specific survival rates were 1.6%, 94.6%, and 99.5%, respectively. Six patients (1.6%) experienced recurrence, five of whom underwent additional surgery. Those with no risk factors did not exhibit recurrence. A total of 215 (58.1%) patients underwent additional surgery after ESD, 21 (9.7%) of whom exhibited LN metastasis. Among 16 patients who underwent additional surgery due to lymphovascular invasion, three (18.8%) had LN metastasis. Multivariate logistic regression analysis identified lymphatic invasion as a significant risk factor for LN metastasis (odds ratio 3.9, 95% confidence interval 1.0-14.6, P = 0.0421). Conclusions The JSCCR guidelines have clinical validity, and immunohistochemical lymphatic evaluation findings potentially predict LN metastasis for T1 CRC after ESD.