Histopathologic determinants of regional lymph node metastasis in early colorectal cancer
Histopathologic determinants of regional lymph node metastasis in early colorectal cancer
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DOI：
10.1002/cncr.23248
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发表时间：
2008-02-15
期刊：
影响因子：
6.2
通讯作者：
Ishii, Toshiharu
中科院分区：
文献类型：
--
作者：
Ishikawa, Yukio;Akishima-Fukasawa, Yuri;Ishii, Toshiharu
背景。早期结直肠癌（ECC）经内镜局部切除可治愈；然而，10%的ECC患者表现为淋巴结（LN）转移。在目前的研究中，通过免疫组织化学与淋巴内皮透明质酸受体1 （LYVE-1）抗体区分淋巴管和血管，研究了ECC患者LN转移的准确预测因素。71例ECC患者的结直肠组织标本，包括28例区域性LN转移患者，用LYVE-1 β -连环蛋白、claudin-3、claudin-4和细胞角蛋白抗体进行免疫染色。根据特定的组织病理学参数，探讨组织病理学变量对ECC淋巴结转移的意义。LYVE-1免疫组化证实的淋巴浸润主要见于原发肿瘤周围的粘膜下区，在肿瘤内少见。侵袭前癌细胞中P-catenin、claudin-3和claudin-4的表达模式与LN状态无关。在单因素分析中，肿瘤大小、浸润深度、组织学肿瘤类型、出芽形成和淋巴浸润对LN状态有统计学意义；然而，只有2个因素-淋巴浸润和侵袭前沿的芽殖形成-是ecl转移的独立预测因素。LYVE-1免疫组织化学似乎是一种有效的方法，用于检测癌细胞侵袭的淋巴管，肿瘤周围粘膜下层的详细检查可能对预测LN转移很重要。当组织病理学观察到ECC患者的淋巴浸润和芽肿形成时，可能需要额外的治疗，如辅助化疗或局部LN的根治性切除术。
BACKGROUND. Early colorectal cancer (ECC) is curable by endoscopic local resection; however, 10% of patients with ECC exhibit lymph node (LN) metastasis. In the current study, accurate predictors for LN metastasis in patients with ECC were examined by using immunohistochemistry with the lymphatic endothelial hyaluronan receptor 1 (LYVE-1) antibody to discriminate between lymphatics and blood vessels.METHODS. Colorectal tissue specimens obtained from 71 patients with ECC, including 28 patients with regional LN metastasis, were immunostained with antibodies against LYVE-1 beta-catenin, claudin-3, claudin-4, and cytokeratin. The significance of the histopathologic variables for LN metastasis in ECC was investigated on the basis of specific histopathologic parameters.RESULTS. Lymphatic invasion confirmed by LYVE-1 imnumohistochemistry was observed mainly in the submucosal area around the primary tumor and rarely was observed in the tumor. Expression patterns of P-catenin, claudin-3, and claudin-4 in cancer cells at the invasive front were irrelevant to LN status. Tumor size, depth of invasion, histologic tumor type, budding formation, and lymphatic invasion were statistically significant to LN status in univariate analysis; however, only 2 factors-lymphatic invasion and budding formation at the invasive front-were independent predictors of LN metastasis in ECC.CONCLUSIONS. LYVE-1 immunohistochemistry appeared to be a useful method for detecting lymphatics invaded by cancer cells, and detailed examination of the submucosa around the tumor may be important for predicting LN metastasis. when lymphatic invasion and budding formation are observed histopathologically in patients with ECC, additional therapy, such as adjuvant chemotherapy or a curative resection of the regional LN, may be required.