结直肠腺癌淋巴结转移的临床病理意义

Clinicopathological analysis of lymph node metastasis in colorectal adenocarcinoma

目的分析淋巴结转移与结直肠腺癌临床病理参数及预后的相关性，探讨其临床病理意义。方法回顾性分析2011年2月至2015年8月期间北京同仁医院病理科阅片的133例结直肠腺癌根治术患者的淋巴结转移情况及临床病理特征，并结合患者随访资料分析淋巴结转移与各临床病理学参数及预后之间的关系。结果133例中69例存在淋巴结转移（淋巴结转移组），64例无淋巴结转移（淋巴结未转移组）。与淋巴结未转移组比较，淋巴结转移组更易发生神经侵犯（20．29％比3．13％）和脉管侵犯（36．23％比3．13％），肿瘤浸润深度更深（浆膜外：1．45％比0），肿瘤分化更低（低分化：26．09％比14．06％），死亡（11．59％比1．56％）及远处转移比例（17．39％比4．69％）更高（均P〈0．05）。淋巴结转移组中不同淋巴结N分期（N0、N1a、N1b、N2a、N2b）在神经侵犯、脉管侵犯、环周切缘、肿瘤最大径、浸润深度、肿瘤分化、死亡及远处转移方面差异均有统计学意义（均P〈0．05）。而检出淋巴结数目〈12个的患者与检出淋巴结数目≥12个的患者各临床参数差异无统计学意义（均P〉0．05）。结论淋巴结转移及其分期与神经侵犯、脉管侵犯、肿瘤浸润深度、肿瘤分化、死亡及远处转移具有明显的相关性，而淋巴结数目〈12个或≥12个与临床病理参数及预后无关。

Objective To analyze the correlation of lymph node metastasis with clinicopathological parameters and outcomes of colorectal adenoearcinoma, and to explore its clinicopathological significance. Methods The lymph node metastasis and clinicopathological features of 133 colorectal adenoeareinoma patients whose specimens were interpreted in Department of Pathology of Beijing Tongren Hospital between February 2011 and August 2015 were retrospectively analyzed. The relationship between the lymph node metastasis and elinicopathological features as well as outcomes was also analyzed according to the follow-up data of these patients. Results Among the 133 cases, 69 had lymph node metastasis, and the other 64 had no lymph node metastasis. Compared with the non-lymph node metastasis group, the lymph node metastasis group had higher prevalence of neural invasion （20. 29% vs 3.13% ） and vascular invasion （36. 23% vs 3.13% ） , deeper tumor invasion （ beyond the serosa： 1.45% vs 0） , lower tumor differentiation （ poorly differentiated： 26. 09% vs 14. 06% ）, higher mortality （ 11.59% vs 1.56% ） and distant metastasis （ 17.39% vs 4. 69% ） （ all P 〈 0. 05 ）. In the lymph node metastasis group, intra-group comparison among patients of different lymph node N staging （NO, Nla, Nlb, N2a, N2b） also showed statistically significant differences in neural invasion, vascular invasion, circumferential resection margin, maximum diameter of the tumor, depth of tumor invasion, tumor differentiation, survival, and distant metastasis （ all P 〈 0. 05 ）. There were no statistically significant differences between the patients with lymph node metastases 〈 12 and those with lymph node metastases ≥ 12 in these clinicopathological parameters（ all P 〉 0. 05）. Conclusions Presence/absence of lymph node metastasis and lymph node stage may be correlated with neural invasion, vascular invasion, depth of tumor invasion, tumor differentiation, survival, and distant metastasis. However, no marked relationship was detected of the number of lymph node metastases （ 〈 12 or ≥ 12） with elinieopathologieal parameters and outcomes.