Risk factors for occult lymph node metastasis of colorectal cancer invading the submucosa and indications for endoscopic mucosal resection
Risk factors for occult lymph node metastasis of colorectal cancer invading the submucosa and indications for endoscopic mucosal resection
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DOI：
10.1007/s10350-007-0263-0
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发表时间：
2007-09-01
影响因子：
3.9
通讯作者：
Kitano, Seigo
中科院分区：
文献类型：
--
作者：
Yasuda, Kazuhiro;Inomata, Masafumi;Kitano, Seigo
目的：虽然早期结直肠癌患者组织学显性淋巴结转移的危险因素已被阐明，但隐匿性淋巴结转移的危险因素尚不清楚。本研究旨在明确侵犯粘膜下层的结直肠癌患者包括隐匿性转移在内的淋巴结转移的危险因素，并确定早期结直肠癌的内窥镜切除标准。方法：对86例手术切除的侵犯粘膜下层的结直肠癌患者的淋巴结转移危险因素(包括隐性转移)进行分析。用细胞角蛋白抗体CAM5.2进行免疫组织化学染色。结果：隐匿性和显性转移率分别为13%(11/86)和13%(10/75)。多因素分析显示血管侵犯(P=0.001)和肿瘤萌生(P=0.003)是包括隐匿性转移在内的淋巴结转移的独立危险因素。黏膜下侵犯1,000微米的肿瘤，无淋巴结转移。黏膜下侵犯1,000~2,000微米和<2,000微米的肿瘤，其淋巴结转移率分别为21%和37%。在综合考虑各种危险因素后，在既没有血管侵犯也没有肿瘤萌芽和粘膜下侵犯的肿瘤中没有淋巴结转移。
PURPOSE: Although risk factors for histologically overt lymph node metastasis in patients with early-stage colorectal cancer have been clarified, the risk factors for occult lymph node metastasis are not clear. This study was designed to clarify risk factors for lymph node metastasis, including occult metastasis, in patients with colorectal cancer invading the submucosa and to determine the criteria for endoscopic resection of early colorectal cancer. METHODS: The risk factors for lymph node metastasis, including occult metastasis, were analyzed in 86 cases of surgically resected colorectal cancer invading the submucosa. The lymph nodes were assessed by immunohistochemistry with cytokeratin antibody CAM5.2. RESULTS: The frequencies of overt and occult metastasis to the lymph nodes were 13 percent (11/86) and 13 percent (10/75), respectively. Multivariate analysis showed vascular invasion (P=0.001) and tumor budding (P=0.003) to be independent risk factors for lymph node metastasis, including occult metastasis. For tumors with submucosal invasion < 1,000 mu m, no lymph node metastasis was found. The frequencies of lymph node metastasis for tumors with submucosal invasion of 1,000 to 2,000 mu m and >2,000 mu m were 21 and 37 percent, respectively. In considering combinations of risk factors, there was no lymph node metastasis in tumors having neither vascular invasion nor tumor budding and submucosal invasion of