Meta-analysis of Histopathological Features of Primary Colorectal Cancers that Predict Lymph Node Metastases
Meta-analysis of Histopathological Features of Primary Colorectal Cancers that Predict Lymph Node Metastases
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DOI：
10.1007/s11605-012-1827-4
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发表时间：
2012-05-01
影响因子：
3.2
通讯作者：
Lowry, Ann C.
中科院分区：
文献类型：
--
作者：
Glasgow, Sean C.;Bleier, Joshua I. S.;Lowry, Ann C.
结直肠癌的治疗决定取决于淋巴结状态。虽然原发性肿瘤的一些组织病理学特征与淋巴结扩散相关，这些危险因素的相对影响还没有很好地量化。本研究旨在系统地回顾已发表的关于原发性结直肠癌的组织病理学特征与淋巴结转移的存在的研究，并确定只有原发病灶可用于研究时某些因素在预测淋巴结转移方面的可靠性。使用EMBASE和奥维德MEDLINE数据库进行文献检索，并对1984年至2008年中期与结直肠癌（任何T分期）淋巴转移相关的所有文献进行人工参考检查。从76篇文献中选择数据，确定每个组织病理学特征对淋巴转移可能性的相对影响。进行固定效应荟萃分析，结果报告为Mantel-Haenszel比值比（OR）。在分析的42个组织病理学特征中，只有40.4%的报告在> 2篇文章中。最常报告的危险因素的前四分位数的阳性预测值为25.5- 86.4%。在通常报告的组织病理学结果中，淋巴管浸润（OR，8.62）在预测淋巴结扩散方面显著优于肿瘤深度（T2 vs. T1; OR，2.62）和总体分化（OR，2.38）。对于直肠癌亚组，危险因素在预测能力上不同于整个结直肠癌组;浸润前沿分化差（OR，6.08）和肿瘤出芽（或，该文献检索受限于仅检查直肠癌的少量研究以及组织学和/或病理学变化的潜在变化。结直肠癌的组织病理学特征不能可靠地预测淋巴结转移。与淋巴结疾病高度相关的几个风险因素不是标准病理报告的常规组成部分。在进一步研究建立预测淋巴结扩散的组织病理学或分子模式之前，仅根据这些因素做出治疗决定时应谨慎。
Treatment decisions for colorectal cancer vary based on lymph node status. While some histopathological features of the primary tumor correlate with lymph node spread, the relative influences of these risk factors are not well quantified.This study aims to systematically review published studies relating histopathological features of primary colorectal cancer to the presence of lymph node metastases and to determine how reliable certain factors might be at predicting nodal metastasis when only the primary lesion is available for study.Inclusive literature search using EMBASE and Ovid MEDLINE databases plus manual reference checks of all articles correlating lymphatic spread with colorectal cancer (any T stage) from 1984 to mid-2008 was performed.This search generated two levels of screening utilized on 602 citations, yielding 123 articles for full review. Data reported from 76 articles were chosen.The relative influence of each histopathological feature on the likelihood of lymphatic metastases was determined. Fixed-effects meta-analysis was performed, and results were reported as Mantel-Haenszel odds ratios (OR).Of 42 histopathological features analyzed, only 40.4% were reported in > 2 articles. The positive predictive values for the top quartile of most frequently reported risk factors were 25.5-86.4%. Among the commonly reported histopathological findings, lymphatic invasion (OR, 8.62) significantly outperformed tumor depth (T2 vs. T1; OR, 2.62) and overall differentiation (OR, 2.38) in predicting nodal spread. For the rectal cancer subset, risk factors differed from the overall colorectal group in predictive ability; poor differentiation at the invasive front (OR, 6.08) and tumor budding (OR, 5.82) were the most predictive.This literature search is limited by the small number of studies examining only rectal cancers and the potential changes in histological and/or surgical techniques over the study period.No single histopathological feature of colorectal cancer reliably predicted lymph node metastases. Several risk factors that correlate highly with nodal disease are not routine components of standard pathology reports. Until further research establishes histopathological or molecular patterns for predicting lymph node spread, caution should be exercised when basing treatment decisions solely on these factors.