Lymph node metastasis in T1 adenocarcinoma of the colon and rectum
Lymph node metastasis in T1 adenocarcinoma of the colon and rectum
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DOI：
10.1016/j.gassur.2004.09.038
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发表时间：
2004-12-01
影响因子：
3.2
通讯作者：
Paty, PB
中科院分区：
文献类型：
--
作者：
Okabe, S;Shia, JR;Paty, PB
结直肠癌的生物学特性根据大肠内的位置而不同。为了评估肿瘤位置作为淋巴结转移 (LNM) 危险因素的临床意义，我们对结肠和直肠 T1 腺癌进行了详细的病理学检查。从两个机构的前瞻性临床数据库中鉴定出接受根治性切除术治疗的 T1 期结肠和直肠腺癌 (n = 428)。肿瘤位置被指定为右结肠（盲肠至横结肠）、左结肠（脾曲至乙状结肠）或直肠（距AV 0-18 cm）。检查病理切片，使用光学测微计量化粘膜下浸润范围（sin 宽度、sin 深度），并记录癌症及其浸润边缘的形态特征。 LNM 的总体率为 10%。在单变量分析中，与左结肠 (13/160, 8%, p = .04) 或右结肠 (3/92, 3%, p = .003) 相比，LNM 在直肠 (27/176, 15%) 中更为常见。然而，在多变量分析中，深部粘膜下侵犯和淋巴管侵犯是独立且显着的危险因素，而肿瘤位置则不是。随着 T1 期结直肠癌的位置变得更加远端，其发生 LNM 的风险逐渐升高。然而，左结肠癌和直肠癌中 LNM 发生率的增加可以用高风险病理特征的患病率较高来解释。在早期结直肠癌中，肿瘤形态是转移行为最强的临床预测因子。 (C) 2004 年消化道外科学会。
The biology of colorectal cancer differs according to location within the large intestine. To evaluate the clinical significance of tumor location as a risk factor for lymph node metastasis (LNM), we performed a detailed pathological review of T1 adenocarcinomas of the colon and rectum. T1 adenocarcinomas of the colon and rectum treated by radical resection (n = 428) were identified from prospective clinical databases at two institutions. Tumor location was assigned as right colon (cecum to transverse), left colon (splenic flexure to sigmoid), or rectum (0-18 cm from AV). Pathology slides were reviewed, extent of submucosal invasion (sin width, sin depth) was quantified using an optical micrometer, and morphologic features of the cancer and its infiltrating margin were recorded. The overall rate of LNM was 10%. On univariate analysis, LNM was significantly more common in the rectum (27/176, 15%) compared to the left colon (13/160, 8%, p = .04) or right colon (3/92, 3%, p = .003). However, on multivariate analysis, deep submucosal invasion and lymphovascular invasion were independent and significant risk factors, whereas tumor location was not. T1 colorectal cancers have a progressively higher risk of LNM as their location becomes more distal. However, the increasing rate of LNM observed in cancers of the left colon and rectum is explained by a higher prevalence of high-risk pathologic features. In early colorectal cancers, tumor morphology is the strongest clinical predictor of metastatic behavior. (C) 2004 The Society for Surgery of the Alimentary Tract.