T1期直肠癌淋巴结转移相关临床病理因素分析

The clinical pathological features correlated with lymph node metastasis in T1 stage rectal carcinoma

目的研究与T1期直肠癌淋巴结转移相关的临床病理因素,为临床医生选择适当的治疗方式及判断预后提供依据。方法本研究选取T1期直肠癌病例,分析相关临床和组织病理学指标与淋巴结转移、远处转移和生存的关系。结果共计251例根治性手术切除的连续性T1期直肠癌病例,淋巴结转移率11.2%(28/251)。3年、5年和10年的总生存率分别为98.6%、96.8%和94.9%。有淋巴结转移的病例3年、5年和10年的总生存率分别为100%、95.6%和90.9%;无淋巴结转移的病例3年、5年和10年的总生存率分别为99%、96.9%和95.4%,高于有淋巴结转移组,但差异无统计学意义。单因素分析显示患者的年龄(P=0.05)、腺瘤背景(P<0.01)、组织学分化(P<0.01)、筛状结构(P=0.03)、低分化肿瘤细胞簇(PDC)(P=0.02)、肿瘤出芽(TB)(P=0.01)、淋巴管血管侵犯(LVI)(P <0.01)、黏膜下静脉侵犯(VI)(P <0.01)、浸润深部腺体类型(P=0.04)与淋巴结转移有关。多因素logistic回归分析显示患者年龄(P=0.02)、腺瘤背景(P <0.01)、组织学分化(P=0.04)、黏膜下静脉侵犯(P=0.02)是淋巴结转移的危险因素。单因素分析显示肿瘤浸润最深处的腺体为开放型与淋巴结转移相关(P=0.04)。腺体的开放型还显示与肿瘤大体平坦型(P=0.03)、无腺瘤背景(P=0.03)、黏膜肌完全消失(P=0.05)、高级别肿瘤出芽(P <0.001)和肿瘤内坏死(P <0.001)有关。结论本项研究验证了多种已知的组织学特征与T1期直肠癌淋巴结转移的相关性,并且提出了筛状结构、腺体为开放型与淋巴结转移相关。

Objective To investigate the association between clinical pathological factors and lymph node metastases in T1 stage rectal carcinoma.Methods We retrospectively reviewed the 251 consecutive T1 rectal carcinoma patients who had undergone radical colectomy with lymph node dissection in a single institution.The histopathological factors were reviewed.The correlation between these factors and lymph node metastasis,tumor recurrence and survival were analyzed.Results A total of 251 consecutive patients with T1 rectal carcinoma were included in this study.Lymph node metastasis occurred in 11.2%(28/251)of patients.The 3,5 and 10 years overall survival was 98.6%,96.8%and 94.9%,respectively,for all patients.The 3,5 and 10 years overall survival of patients with or without lymph node metastasis were 100%,95.6%and 90.9%or 99%,96.9%and 95.4%,respectively.There was no statistical difference between the two group in overall survival.Univariate analysis showed that each of the following histopathological factors had a significant influence on lymph node metastasis,which are patients′age(P=0.05);adenomatous background(P<0.01),tumor differentiation(P<0.01),cribriform structure(P=0.03),PDC(P=0.02),tumor budding(P=0.01),lymphvascular invasion(P<0.01),submucosa venous invasion(P<0.01)and glandular pattern at the submucosal invasive front(P=0.04).Multivariate analysis showed that age(P=0.02),no adenomatous background(P<0.01),tumor differentiation(P=0.04)and submucosa venous invasion(P=0.02)were significantly associated with lymph node metastasis.We also found that open-type glandular pattern is also correlated with gross plat-type(P=0.03);no adenoma background(P=0.03),complete disruption of the muscularis mucosa(P=0.05),high grade tumor budding(P<0.001)and tumor necrosis(P<0.001).Conclusion In the present study,we not only verified the effectiveness of those classical pathological factors,but proposed the cribriform structure,open-type glandular pattern at the submucosal invasive front in predicting lymph node metastasis in T1 stage rectal carcinoma.