联合肿瘤芽殖与淋巴管浸润预估大肠癌淋巴结转移的研究

目的 联合肿瘤芽殖与淋巴管浸润预估大肠癌淋巴结转移,旨在确立一组与大肠癌淋巴结转移密切相关的指标.方法 回顾性调查施行根治手术并具有完整临床病理资料的大肠癌病例168例,评价芽殖或与淋巴管浸润联合预估淋巴结转移的可行性.结果 肿瘤芽殖与淋巴结转移程度、数目、浸润深度、临床分期等病理生物学指标密切相关;肿瘤芽殖单独预测淋巴结转移的灵敏度、特异性、阳性预测值、阴性预测值分别为:86%、45%、49%、84%;而联合淋巴管的预测灵敏度、特异性、阳性预测值、阴性预测值分别为:88%、44%、49%、85%.结论 术前通过超声纤维结肠镜和螺旋CT的准确判断,结合肿瘤芽殖这一病理生物学指标预估伴发淋巴结转移的风险,对选择个体化的合理治疗方案具有非常重要的实践意义.

The Study on the Combined Examination of Lymphovascular Invasion and Tumor Budding in the Prediction of Lymph Node Metastasis in Colorectal Carcinoma

Objective To evaluate the value of examination of tumor budding in combination with lymphatic invasion to predict lymph node metastasis in colorectal carcinoma. Methods The relationship between the lymph node metastasis and the clinical and pathologic characteristics including tumor budding was retrospectively studied in 168 patients with colorectal cancer treated by radical excision from January 2000 to December 2001. Results The tumor budding was strongly correlated with the degree and number of lymph node metastasis, the depth of cancer invasion, and clinical stage. The sensitivity, specificity, positive predictive value,and negative predictive value of tumor budding alone for lymph node metastasis were 86% ,45% , 49%, and 84%, respectively, whereas the combination of budding and lymphovascular invasion were 88% ,44%, 49%, and 85%, respectively. Conclusion Preoperative ultrasonic fibrocolonoscope, spiral CT in combination with tumor budding can accurately estimate the risk of lymph node metastasis in colorectal cancer. This technique might be of particular value in the individualized treatment of patients with colorectal carcinoma.