Purpose: Submucosal invasive colorectal carcinoma (SICC) exhibits lymph node metastasis in about 10% of patients. Therefore, endoscopic resection is insufficient for cases of SICC at risk of lymph node metastasis, and...Purpose: Submucosal invasive colorectal carcinoma (SICC) exhibits lymph node metastasis in about 10% of patients. Therefore, endoscopic resection is insufficient for cases of SICC at risk of lymph node metastasis, and surgical resection accompanied with lymph node dissection is necessary. However, because additional intestinal resection is unnecessary for cases without lymph node metastasis, more rigid criteria are required in order to decrease the incidence of unnecessary further intestinal resection. We retrospectively identified predictive factors for lymph node metastasis in submucosal invasive colorectal carcinoma. Methods: One hundred and two patients who underwent intestinal resection as the first treatment or additional intestinal resection after endoscopic resection at our department between 1999 and 2012 were enrolled in the present study. Clinicopathological factors were analyzed to determine predictive factors related to lymph node metastasis. Results: The multivariate analysis revealing only depth of submucosal invasion (≤2700 μm) was found to be a significant, independent predictive factor of lymph node metastasis (P = 0.04, Odds ratio: 4.18, 95% CI: 1.06 - 16.40). Conclusion: It is considered that the refinement of the criteria in the present study will be very useful, especially in the patients for whom careful judgment is required when considering additional intestinal resection.展开更多
目的探究T_(1)期结直肠癌黏膜下浸润深度不同评估标准的应用特点和临床价值。方法回顾性收集2013年1月至2021年12月广东省中医院胃肠肿瘤中心行根治性手术切除的T_(1)期结直肠癌患者的临床资料,统计黏膜下浸润深度测量值、Kikuchi分级和...目的探究T_(1)期结直肠癌黏膜下浸润深度不同评估标准的应用特点和临床价值。方法回顾性收集2013年1月至2021年12月广东省中医院胃肠肿瘤中心行根治性手术切除的T_(1)期结直肠癌患者的临床资料,统计黏膜下浸润深度测量值、Kikuchi分级和Haggitt分级3种不同评估标准下的诊断结果,对3种评估方式的准确性、主要差异和影响因素进行分析。结果共纳入46例pT_(1)期结直肠癌患者,其中男性17例,女性29例,中位年龄65(40~85)岁。病变位于升结肠9例、横结肠2例、降结肠3例、乙状结肠11例、直肠21例;带蒂息肉26例(56.5%),无蒂息肉20例(43.5%)。中位黏膜下浸润深度3.5(0.2~11.0)mm,黏膜下浸润深度<1 mm者10例(21.7%),黏膜下浸润深度≥1 mm 36例(78.3%)。Haggitt分级下,评估为2级22例(47.8%)、3级4例(8.7%)、4级20例(43.5%)。Kikuchi分级下,评估为1级24例(52.2%)、2级14例(30.4%)、3级8例(17.4%)。量化测量、Kikuchi分级、Haggitt分级3种评估方式下,判断为黏膜下深度浸润的比例分别为78.3%(36/46)、47.8%(22/46)、43.5%(20/46);预测淋巴结转移的敏感性分别为100%、100%、50%,特异性分别为23.8%、57.1%、57.1%。量化测量和Kikuchi分级结果一致性最高(69.6%),两者呈正相关关系(r=0.657,P<0.001);量化测量和Haggitt分级结果一致性最低(21.7%)。量化测量值受黏膜肌层毁损和息肉类型的影响(均P<0.001);Kikuchi分级受黏膜肌层毁损的影响(P=0.003)。结论3种评估方式中,Kikuchi分级预测淋巴结转移的特异性和敏感性最高,且不受息肉类的影响。黏膜下浸润测量值因受黏膜肌层状态和息肉类型的影响而存在较大的测量误差。Haggitt分级敏感性最低且不适用于无蒂息肉。但3种评估标准下均存在高估淋巴结转移的风险,导致过度手术治疗的弊端。展开更多
文摘Purpose: Submucosal invasive colorectal carcinoma (SICC) exhibits lymph node metastasis in about 10% of patients. Therefore, endoscopic resection is insufficient for cases of SICC at risk of lymph node metastasis, and surgical resection accompanied with lymph node dissection is necessary. However, because additional intestinal resection is unnecessary for cases without lymph node metastasis, more rigid criteria are required in order to decrease the incidence of unnecessary further intestinal resection. We retrospectively identified predictive factors for lymph node metastasis in submucosal invasive colorectal carcinoma. Methods: One hundred and two patients who underwent intestinal resection as the first treatment or additional intestinal resection after endoscopic resection at our department between 1999 and 2012 were enrolled in the present study. Clinicopathological factors were analyzed to determine predictive factors related to lymph node metastasis. Results: The multivariate analysis revealing only depth of submucosal invasion (≤2700 μm) was found to be a significant, independent predictive factor of lymph node metastasis (P = 0.04, Odds ratio: 4.18, 95% CI: 1.06 - 16.40). Conclusion: It is considered that the refinement of the criteria in the present study will be very useful, especially in the patients for whom careful judgment is required when considering additional intestinal resection.
文摘目的探究T_(1)期结直肠癌黏膜下浸润深度不同评估标准的应用特点和临床价值。方法回顾性收集2013年1月至2021年12月广东省中医院胃肠肿瘤中心行根治性手术切除的T_(1)期结直肠癌患者的临床资料,统计黏膜下浸润深度测量值、Kikuchi分级和Haggitt分级3种不同评估标准下的诊断结果,对3种评估方式的准确性、主要差异和影响因素进行分析。结果共纳入46例pT_(1)期结直肠癌患者,其中男性17例,女性29例,中位年龄65(40~85)岁。病变位于升结肠9例、横结肠2例、降结肠3例、乙状结肠11例、直肠21例;带蒂息肉26例(56.5%),无蒂息肉20例(43.5%)。中位黏膜下浸润深度3.5(0.2~11.0)mm,黏膜下浸润深度<1 mm者10例(21.7%),黏膜下浸润深度≥1 mm 36例(78.3%)。Haggitt分级下,评估为2级22例(47.8%)、3级4例(8.7%)、4级20例(43.5%)。Kikuchi分级下,评估为1级24例(52.2%)、2级14例(30.4%)、3级8例(17.4%)。量化测量、Kikuchi分级、Haggitt分级3种评估方式下,判断为黏膜下深度浸润的比例分别为78.3%(36/46)、47.8%(22/46)、43.5%(20/46);预测淋巴结转移的敏感性分别为100%、100%、50%,特异性分别为23.8%、57.1%、57.1%。量化测量和Kikuchi分级结果一致性最高(69.6%),两者呈正相关关系(r=0.657,P<0.001);量化测量和Haggitt分级结果一致性最低(21.7%)。量化测量值受黏膜肌层毁损和息肉类型的影响(均P<0.001);Kikuchi分级受黏膜肌层毁损的影响(P=0.003)。结论3种评估方式中,Kikuchi分级预测淋巴结转移的特异性和敏感性最高,且不受息肉类的影响。黏膜下浸润测量值因受黏膜肌层状态和息肉类型的影响而存在较大的测量误差。Haggitt分级敏感性最低且不适用于无蒂息肉。但3种评估标准下均存在高估淋巴结转移的风险,导致过度手术治疗的弊端。
