Risk of Lymph Node Metastasis in T1 Carcinoma of the Colon and Rectum
Tóm tắt
PURPOSE: Several recent reports of high local recurrence and lymph node metastasis in T1 carcinoma of the rectum prompted us to study the risk factors for lymph node metastasis in these lesions.
METHODS: We reviewed the clinical records of 7,543 patients who underwent operative treatment for carcinoma of the colon and rectum from 1979 to 1995. Only patients with sessile T1 lesions who underwent colorectal resection were included in the study, yielding an analysis cohort of 353 patients. The following carcinoma-related variables were assessed: size, mucinous subtype, carcinomatous component, grade, site in colon and rectum, lymphovascular invasion, and depth of submucosal invasion. For the depth, the submucosa was divided into upper third (sm1), middle third (sm2), and lower third (sm3). Chi-squared tests and logistic regression were used to evaluate the variables as potential risk factors for lymph node metastasis.
RESULTS: The incidence of T1 lesions was 8.6 percent. In the analysis cohort, the lymph node metastasis rate was 13 percent. Significant predictors of lymph node metastasis both univariately and multivariately were sm3 (P = 0.001), lymphovascular invasion (P = 0.005), and lesions in the lower third of the rectum (P = 0.007). Poorly differentiated carcinoma was significant univariately (P = 0.001) but not in the multivariate model. No other parameter was associated with a significant risk.
CONCLUSIONS: T1 colorectal carcinomas with lymphovascular invasion, sm3 depth of invasion, and location in the lower third of the rectum have a high risk of lymph node metastasis. These lesions should have an oncologic resection. In a case of the lesion in the lower third of the rectum, local excision plus adjuvant chemoradiation may be an alternative.
Tài liệu tham khảo
BC Morson HJ Bussey (1970) ArticleTitlePredisposing causes of intestinal cancer Curr Probl Surg . 1–46
G Nusco W Mansmann W Partzsch et al. (1997) ArticleTitleInvasive carcinoma in colorectal adenomas Endoscopy 29 626–631
T Muto T Sawada K Sugihara (1991) ArticleTitleTreatment of carcinoma in adenomas World J Surg 15 35–40
S Nivatvongs (1986) ArticleTitleComplications in colonoscopic polypectomy Dis Colon Rectum 29 825–830
P Hermanek FP Gall (1986) ArticleTitleEarly (microinvasive) colorectal carcinoma Int J Colorectal Dis 1 79–84
H Shinya WI Wolff (1979) ArticleTitleMorphology, anatomic distribution, and cancer potential of colonic polyps Ann Surg 190 679–683
SP Huddy EM Husband MG Cook NM Gibbs CG Marks RJ Heald (1993) ArticleTitleLymph node metastasis in early cancer Br J Surg 80 1457–1458
J Garcia-Aguilar A Mellgren P Sirivongs D Buie RD Madoff DA Rothenberger (2000) ArticleTitleLocal excision of rectal cancer without adjuvant therapy Ann Surg 3 345–351
JP Lamont TM McCarty RD Digan R Jacobson P Tulanon WE Lichliter (2000) ArticleTitleShould locally excised T1 rectal cancer receive adjuvant chemoradiation Am J Surg 180 402–406
A Chakravati CC Compton PC Shellito et al. (1999) ArticleTitleLong-term follow-up of patients with rectal cancer managed by local excision with and without adjuvant irradiation Ann Surg 230 49–54
NS Goldstein J Hart (1999) ArticleTitleHistologic features associated with lymph node metastasis in stage T1 and superficial T2 rectal adenocarcinomas in abdominoperineal resection specimens Am J Clin Pathol 111 51–58
D Blumberg PB Paty AI Picon et al. (1998) ArticleTitleStage I rectal cancer J Am Coll Surg 186 574–580
PL Baron WE Enker MF Zakowski C Urmacher (1995) ArticleTitleImmediate vs. salvage resection after local treatment for early rectal cancer Dis Colon Rectum 38 177–181
CR Mehta NR Patel (1983) ArticleTitleA network algorithm for the exact treatment of Fisher’s exact test in Rx C contingency tables J Am Statist Assoc 78 427–434
N Mantel W Haenszel (1959) ArticleTitleStatistical aspects of analysis of data from retrospective studies of disease J Natl Cancer Inst 22 719–748
SH Walker DB Duncan (1967) ArticleTitleEstimation of probability of an event as a function of several independent variables Biometrika 54 167–179
AC Broders (1925) ArticleTitleThe grading of carcinoma Minn Med 8 726–730
JT Brodsky GK Richard AM Cohen BD Minsky (1992) ArticleTitleVariables correlated with the risk of lymph node metastasis in early rectal cancer Cancer 69 322–326
HS Cooper LM Deppisch WK Gourley et al. (1995) ArticleTitleEndoscopically removed malignant colorectal polyps Gastroenterology 108 1657–1665
R Bleday E Breen JM Jessup A Burgess SM Sentovich G Steele SuffixJr (1997) ArticleTitleProspective evaluation of local excision for small rectal cancers Dis Colon Rectum 40 388–392
R Kikuchi M Takano K Takagi et al. (1995) ArticleTitleManagement of early invasive colorectal cancer Dis Colon Rectum 38 1286–1295
S Tanaka K Haruma CR Teixeira et al. (1995) ArticleTitleEndoscopic treatment of submucosal invasive colorectal carcinoma with special reference to risk factors for lymph node metastasis J Gastroenterol 30 710–717
S Kyzer LR Begin PH Gordon B Mitmaker (1992) ArticleTitleThe care of patients with colorectal polyps that contain invasive adenocarcinoma Cancer 70 2044–2050
S Nivatvongs A Rojanasakul HM Reiman et al. (1991) ArticleTitleThe risk of lymph node metastasis in colorectal polyps with invasive adenocarcinoma Dis Colon Rectum 34 323–328
RC Haggitt RE Glotzbach EE Soffer LD Wruble (1985) ArticleTitlePrognostic factors in colorectal carcinomas arising in adenomas Gastroenterology 89 328–336
S Coverlizza M Risio A Ferrari CM Fenoglio-Preiser FP Rossini (1989) ArticleTitleColorectal adenomas containing invasive carcinoma Cancer 64 1937–1947
RP Sticca M Rodriguez-Bigas RB Penetrante NJ Petrelli (1996) ArticleTitleCurative resection for stage I rectal cancer Cancer Invest 14 491–497
CW Pollard S Nivatvongs A Rojanasakul HM Reiman RR Dozois (1992) ArticleTitleThe fate of patients following polypectomy alone for polyps containing invasive carcinoma Dis Colon Rectum 35 933–937
M Bouvet M Milas GG Giacco KR Cleary NA Janjan JM Skibber (1999) ArticleTitlePredictors of recurrence after local excision and postoperative chemoradiation therapy of adenocarcinoma of the rectum Ann Surg Oncol 6 26–32
GD Steele SuffixJr JE Herndon R Bleday et al. (1999) ArticleTitleSphincter-sparing treatment for distal rectal adenocarcinoma Ann Surg Oncol 6 433–441
MG Varma SJ Rogers TR Schrock ML Welton (1999) ArticleTitleLocal excision of rectal carcinoma Arch Surg 134 863–868
S Kudo (1993) ArticleTitleEndoscopic mucosal resection of flat and depressed types of early colorectal cancer Endoscopy 25 455–461
A Mellgren P Sirivongs DA Rothenberger RD Madoff J Garcia-Aguilar (2000) ArticleTitleIs local excision adequate therapy for early rectal cancer Dis Colon Rectum 43 1064–1074
HR Bailey WV Huval E Max KW Smith DR Butts LF Zamora (1992) ArticleTitleLocal excision of carcinoma of the rectum for cure Surgery 111 555–561