Clinicopathological differences between colonic and rectal carcinomas: are they based on the same mechanism of carcinogenesis?
Clinicopathological differences between colonic and rectal carcinomas: are they based on the same mechanism of carcinogenesis?
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DOI：
10.1136/gut.45.6.818
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发表时间：
1999-12-01
期刊：
影响因子：
24.5
通讯作者：
Yoshida, S
中科院分区：
文献类型：
--
作者：
Konishi, K;Fujii, T;Yoshida, S
背景——结直肠粘膜病变和浸润性癌的位置存在差异。目的——确定结直肠肿瘤的位置是否反映了癌变途径。方法——研究材料由 5025 名患者经内镜或手术切除的 4147 个肿瘤病变组成。粘膜病变和粘膜下癌在内窥镜或组织学上分为凹陷型和非凹陷型。研究了宏观类型、大小、组织学和位置之间的关系。结果-(a)非凹陷型。 3454个粘膜病变中共有1774个（51%）位于右结肠，1212个（35%）位于左结肠，468个（14%）位于直肠。大于10mm的粘膜病变发生率在右半结肠为10%（185/1774），在左半结肠为21%（254/1212），在直肠为27%（127/468）。具有绒毛成分的粘膜病变发生率在右半结肠为2%（32/1774），在左半结肠为5%（63/1212），在直肠为13%（62/468）。直肠粘膜下癌与粘膜病变的比例（0.064, 30/469）显着高于左结肠（0.034, 43/1279）或右结肠（0.010, 18/1857）。 (b) 抑郁型。右半结肠凹陷型粘膜病变和粘膜下癌的发生率分别为5%（83/1857）和17%（3/18），左半结肠为5%（67/1279）和5%（2/43），直肠为0.2%（1/469）和0%（0/30）。结论-可能存在一些促进粘膜病变进展的机制。左结肠和直肠的侵袭性癌症的病变，而抑郁型病变的从头途径可能与右结肠的某些癌症有关。
Background-There is a difference in the location of colorectal mucosal lesions and invasive cancers.Aims-To ascertain whether the location of colorectal neoplasms reflects the carcinogenesis pathway.Methods-The subject material consisted of 4147 neoplastic lesions that had been resected endoscopically or surgically from 5025 patients. Mucosal lesions and submucosal cancers were classified into depressed and non-depressed types endoscopically or histologically. The relations between macroscopic type, size, histology, and location were investigated.Results-(a) Non-depressed type. A total of 1774 of 3454 (51%) mucosal lesions were located in the right colon, 1212 (35%) in the left colon, and 468 (14%) in the rectum. The incidence of mucosal lesions larger than 10 mm was 10% (185/1774) in the right colon, 21% (254/1212) in the left colon, and 27% (127/468) in the rectum. The incidence of mucosal lesions with villous components was 2% (32/1774) in the right colon, 5% (63/1212) in the left colon, and 13% (62/468) in the rectum. The ratio of submucosal cancers to mucosal lesions was significantly higher in the rectum (0.064, 30/469) than in the left (0.034, 43/1279) or right (0.010, 18/1857) colon. (b) Depressed type. The incidences of depressed type mucosal lesions and submucosal cancers were 5% (83/1857) and 17% (3/18) in the right colon, 5% (67/1279) and 5% (2/43) in the left colon, and 0.2% (1/469) and 0% (0/30) in the rectum, respectively.Conclusion-There may be some mechanisms that promote the progression of mucosal lesions to invasive cancers in the left colon and rectum, whereas a de novo pathway from depressed type lesions may be implicated in some cancers of the right colon.