结直肠癌患者根治术前血清CEA和CA19-9表达水平对预后的预测价值

目的探讨结直肠癌患者根治术前CEA、CA19-9水平对预后的预测价值。 方法回顾性分析复旦大学附属肿瘤医院2003年12月至2007年1月间491例接受根治性切除的Ⅱ、Ⅲ期结直肠癌患者临床资料,包括患者术前血清CEA和CA19-9水平、临床病理资料及预后情况。利用单变量和多变量分析患者年龄、性别、肿瘤部位、肿瘤分化、TNM分期、肿瘤侵犯深度及淋巴结转移个数与预后的关系。 结果患者术前血清CEA和CA19-9水平、TNM分期、淋巴结转移数、肿瘤侵犯深度、肿瘤的分化都与预后相关。在多变量分析中,CEA和CA19-9水平、TNM分期、肿瘤分化是总生存的独立预测因素,CA19-9水平、TNM分期、肿瘤分化是无病生存的独立预测因素。 结论术前血清CA19-9与CEA水平均对结直肠癌患者的预后有预测价值。CA19-9水平应该作为常规的术前检查指标,对CEA检测结果有补充作用。     

Factors predictive of survival in patients with node-positive colorectal cancer in Taiwan

BACKGROUND/AIMS: Preoperative CEA levels, depth of tumor penetration, and the number of positive lymph nodes were reported as independent factors prognostic of survival in colorectal cancer patients. This study was carried out in an effort to evaluate the prognostic significance of these three factors in patients with Dukes' C colorectal cancer in Taiwan. METHODOLOGY: Between 1992 and 1994, a total of 112 patients with node-positive colorectal cancer were evaluated retrospectively at the Veteran General Hospital-Taipei. All patients underwent potentially curative surgery and received 5-fluorouracil based adjuvant chemotherapy. Reference to the Dukes' classification was according to the classical criteria described in 1932 for carcinoma of the rectum and adapted for use in colonic tumors. Data on the location of the tumor, depth of penetration, number of positive lymph nodes, degree of tumor differentiation, and preoperative CEA levels were analyzed to understand their association with survival. Blood samples for CEA measurement were taken a few days before operation. A multivariate analysis using the Cox's proportional hazards regression model was then performed to determine the most important independent predictors of survival among all the possible variables. RESULTS: Using univariate analysis the number of positive lymph nodes (P < 0.001), penetration of the bowel wall (P < 0.001), and preoperative CEA levels (P < 0.001) were found as significant prognostic factors, while the degree of tumor differentiation, location of the tumor, age and sex were not significant. Using multivariate Cox analysis the number of positive lymph nodes, penetration of the bowel wall, and preoperative CEA levels were still found as independent prognostic factors in node-positive colorectal cancer patients. CONCLUSIONS: Data obtained from our study indicates that preoperative CEA levels, depth of tumor penetration, and the number of positive lymph nodes were independent prognostic factors in Dukes' C colorectal cancer patients. They could serve as appropriate modifications of the initial Dukes scheme in node-positive diseases.     

结直肠癌淋巴结转移相关因素的研究进展

结直肠癌淋巴结转移受多种因素的影响,众多因素之间相互联系、相互作用,临床工作中需对各种因素综合分析才能正确地做出诊断和治疗,本文查阅近十年关于结直肠癌淋巴结转移的相关因素的文献,初步总结了目前被普遍认同的影响结直肠癌淋巴结转移的相关因素,为研究结直肠癌淋巴结转移的独立因素提供思路。目前认为肿瘤的浸润深度、原发部位、分化程度、病理类型以及患者的术前血清CEA水平等与结直肠癌的淋巴结转移具有相关性。而肿瘤的大小和大体形态等因素与结直肠癌淋巴结转移是否具有相关性,目前的认识还不一致。造成以上研究结果出现差异的原因可能有:不同学者对于患者选择的差异、样本数量的多少以及采用的标准不同等。     

Treatment strategy for rectal carcinoids: A clinicopathological analysis of 229 cases at a single cancer institution

Background and Aim: A treatment strategy for tumors with only venous invasion and characteristics of small rectal carcinoids with metastasis have not been clearly documented. The present study aims to determine the risk factors for lymph node metastasis and to elucidate characteristics of small tumors with metastasis. Methods: We investigated a total of 229 patients with rectal carcinoids. The relationship between each clinicopathological variable and the presence of lymph node metastasis was evaluated. Results: Tumor size (larger than 10 mm), presence of central depression, depth of tumor invasion, lymphatic invasion, and venous invasion were significantly associated with the incidence of lymph node metastasis (P < 0.001). Multivariate analysis revealed that tumor size (odds ratio: 63.3, P < 0.001) and venous invasion (odds ratio: 40.9, P < 0.001) were independently predictive of lymph node metastasis. In 204 patients with small (no larger than 10 mm) tumors, 10 patients had lymph node metastasis. All 10 tumors had low proliferation values indicated by mitosis and Ki‐67 index. Multivariate analysis for the 204 patients revealed that only venous invasion was independently associated with metastasis (odds ratio: 40.1, P < 0.001). Five‐year disease free survival rates of the total patients with metastasis and without metastasis were 81.1% and 95.5%, respectively (P < 0.001, log‐rank test). Conclusions: Venous invasion as well as tumor size and lymphatic invasion indicates high malignant potential to metastasize to lymph node and would provide useful information in considering the addition of radical surgery. Postoperative pathological examinations of specimens obtained by local resection are very important to avoid underestimation.     

Higher frequencies of numerical aberrations of chromosome 17 in primary gastric cancers are associated with lymph node metastasis

We investigated the correlation between the frequency of numerical aberrations of chromosome 17 and clinicopathological features of gastric cancer. The copy number of chromosome 17 was examined with fluorescence in-situ hybridization (FISH) in frozen specimens from 100 primary gastric cancers. Chromosomal numerical aberrations were diagnosed as chromosomal loss (single signal) or gain (triple or more signals), in each cell. The frequency of numerical aberrations of chromosome 17 correlated significantly with the depth of invasion (P < 0.01), lymph node metastasis (P < 0.0001), lymphatic invasion (P < 0.001), and venous invasion (P < 0.01). Numerical aberrations of chromosome 17 were associated with lymph node metastasis in 32 early gastric cancers. Multiple regression analysis identified the depth of invasion and numerical aberrations of chromosome 17 as independent significant determinants of lymph node metastasis. Our findings suggest that alterations in chromosome 17 may be linked with tumor progression in primary gastric cancer. Our results also indicate that numerical aberrations of chromosome 17 detected by FISH provide important information about the malignant potential (in particular, lymph node metastasis) of primary gastric cancer. (Received Feb. 22, 1998; accepted July 24, 1998)     

A scoring system to predict inferior mesenteric artery lymph node metastasis and prognostic value of its involvement in rectal cancer

Purpose

The aim of this study is to establish a prediction scoring system for inferior mesenteric artery (IMA) lymph node metastasis and to assess the prognostic impact of dissection of positive IMA node on patients with stage III rectal cancer.

Methods

A retrospective study was performed in 264 patients with stage III rectal cancer undergoing curative surgery. Clinicopathological, survival, and recurrence data were compared between 29 patients with positive IMA nodes and 235 patients with negative IMA nodes. Clinicopathological data which were found to be significantly associated with IMA nodal status were incorporated into a scoring system.

Results

In the training samples, tumor differentiation and preoperative serum CEA were significant predictors of IMA node metastasis in multivariate analysis, which were incorporated into a scoring system. Using receiver operating characteristic curve analysis, we determined a cutoff value of 46.5 for scores, at which the system's sensitivity was 86 % and specificity 61 %. When applied to testing sample, the sensitivity was 80 % and specificity 60 %. Survival analysis showed that 5-year disease-free survival rate (5-DFS) and 5-year overall survival (5-OS) in the positive IMA node group (24.4 and 27.6 %, respectively) were significantly lower than in the negative IMA node group (61.8 and 71.3 %, respectively) (P?<?0.001). Furthermore, multivariate analysis indicated that IMA lymph node metastasis was an unfavorable independent prognostic factor for 5-DFS and 5-OS.

Conclusions

IMA lymph node metastasis is an independent poor prognostic factor for stage III rectal cancer. The prediction scoring system for IMA node metastasis would be beneficial in determining the appropriate level of IMA ligation.     

Lymph node metastasis in early gastric cancer: a clinicopathological analysis

BACKGROUND/AIMS: Endoscopic mucosal resection and laparoscopic wedge resection have become more common in the treatment of early gastric cancer. However, lymph node metastasis is a major poor prognostic factor influencing tumor recurrence and survival. To predict the risk of lymph node metastasis in early gastric cancer, the authors conducted a study to investigate the clinicopathologic characteristics of early gastric cancer with lymph node metastasis. METHODOLOGY: From 1982 to 1998, 181 patients of early gastric cancer underwent primary surgery and were included in the study. Patient data was postoperatively reviewed regarding age, gender, tumor size, depth of invasion, histologic differentiation, macroscopic classification and anatomic level of lymph node metastasis. The chi 2 test or Student's t test was used for statistical analysis. Logistic regression analysis was used to evaluate the independent risk factors for lymph node metastasis. RESULTS: Lymph node metastasis was observed in 19 cases (11%). Early gastric cancer with size larger than 4 cm (P < 0.05), with submucosal invasion (P < 0.01), and with poor differentiation (P < 0.05) was associated with higher risk of lymph node metastasis. The macroscopic classification had no predictive value. Multivariate analysis showed that submucosal invasion correlated best with lymph node spread (OR 10.25, 95% CI: 2.10-49.96), followed by tumor size larger than 4 cm (OR 4.99, 95% CI: 1.46-17.05), and poorly differentiated histological subtype (OR 3.31, 95% CI: 1.16-9.45). CONCLUSIONS: Poor differentiation, submucosal invasion and large tumor size were independent risk factors for lymph node metastasis in early gastric cancer. Macroscopic classification was not correlated with lymph node metastasis.     

Sialyl Tn antigen expression is associated with the prognosis of patients with advanced colorectal cancer

BACKGROUND/AIMS: One of the main problems in multimodal cancer treatment is the lack of prognostic parameters for the individual patient. This study was conducted to clarify the prognostic factors in patients with advanced colorectal cancer. METHODOLOGY: We examined DNA ploidy, Ki-67-derived growth fraction and the expression of CA 19-9, Sialyl Tn (STN) and carcinoembryonic antigens (CEA), along with standard clinicopathological variables including age, sex, tumor location, tumor size, cell differentiation, depth of invasion, and lymph node metastasis in 78 patients with advanced colorectal carcinoma, who underwent curative surgical resection. In addition, we determined the prognostic significance of these parameters. RESULTS: Forty-six patients (59.0%) showed aneuploidy and 32 (41.0%) showed diploidy. The Ki-67 labeling index ranged from 13.9-40.3% with a mean of 24.9%. The index was not correlated with standard clinicopathological variables. There was no significant correlation between seropositive rates for CEA, CA 19-9, or STN and standard clinicopathological variables except for age. In tumor tissue, the positive rates for these antigens were 62.8% for CA 19-9, 67.1% for STN, and 96.2% for CEA. There was no significant correlation between positive rates and clinicopathological variables. The expression of STN in serum had the strongest association with survival, followed by lymph node metastasis and expression of STN in tissue. CONCLUSIONS: We conclude that not only lymph node metastasis but also STN expression are important prognostic factors in patients with advanced colorectal carcinoma who undergo curative surgical resection.     

Lymph node metastasis in early gastric cancer with submucosal invasion： Feasibility of minimally invasive surgery

AIM:To explore the feasibility of performing minimally invasive surgery(MIS) on subsets of submucosal gastric cancers that are unlikely to have regional lymph node metastasis.METHOPS:A total of 105 patients underwent radical gastrectomy with lymph node dissection for submucosal gastric cancer at our hospital from January 1995 to December 1995,Besides investigating many clinicopathological features such as tumor size,gross appearance,and differentiation,we measured the depth of invasion into submucosa minutely and analyzed the clinicopathologic features of these patients regarding lymph node metastasis.RESULTS:the rate of lymph node metastasis in cases where the depth of invasion was&lt;500μm,500-200μm,or&gt;2000μm was 9% (2/23),19%(7/36),and 33%(15/46),respectively(P&lt;0.05).In univariate analysis,no significant correlation was found between lymph node metastasis and clinicopathological characteristics such as age,sex,tumor location,gross appearance,tumor differentiation,Lauren‘s classification,and lymphatic invasion,In multivariate analysis,tumor size(&gt;4cm vs≤2cm,odds ratio=4。80,P=0.04)and depth of invasion(&gt;2000μm vs ≤500μm,odds ratio=6.81,P=0.02)were significantly correlated with lymph node metastasis,Combining the depth and size in cases where the depth of invasion was less than 500μm,we found that lymph node metastasis occurred where the tumor size was greater than 4 cm.In cases where the tumor size was less than 2 cm,lymph node metastasis was found only where the depth of tumor invasion was more than 2000μm.CONCLUSION:MIS can be applied to submucosal gastric cancer that is less than 2 cm in size and 500μm in depth.     

104例直肠癌患者淋巴结转移情况及其相关因素分析

目的探讨影响直肠癌患者淋巴结转移的相关因素,为临床诊断、治疗和预后评估提供参考。方法回顾性分析104例手术治疗的直肠腺癌患者的临床病理资料,对可能与其淋巴结转移有关的因素进行单因素和多因素Logistic回归分析。结果本组淋巴结转移率为45.19%;肿瘤分化程度低、浸润程度深及第二号人表皮生长因子受体（C-erbB-2）表达阳性者淋巴结转移率显著升高（P〈0.05）,三者均为影响直肠癌患者淋巴结转移的重要因素,尤以C-erbB-2表达为著（P〈0.05）。结论直肠癌淋巴结转移与肿瘤浸润深度、分化程度和C-erbB-2表达密切相关,尤以C-erbB-2表达为著;临床对相关患者应于术中尽可能彻底清除引流区域内的淋巴结、术后进行积极辅助性治疗,以减少术后复发、提高生存率。     

DNA index as a significant indicator of lymph node metastasis and local recurrence of rectal cancer

To confirm the prognostic significance of the DNA index (DI) in cases of rectal cancer, the nuclear DNA content of tumor cells was examined in 184 cases of rectal cancer treated with curative surgery, and the incidence of lymph node metastasis and recurrence of the cancer was analyzed. The incidence of lymph node metastasis was 43.9 percent in cases with aneuploidy (DI above 1.5), being statistically different from the 18.0 percent incidence in cases with diploidy (P <0.001). Although the extent of lymph node metastasis was limited to adjacent lymph nodes in cases with diploidy, distant lymph node metastases were frequent in cases with aneuploidy, especially in those with a DI above 1.5. Furthermore, the incidence of recurrence of cancer, and especially of local recurrence, was significantly higher (P <0.001) in cases with aneuploidy (DI above 1.5) than in cases with diploidy and aneuploidy (DI below 1.4). These findings indicate the significant value of the DNA index for the prediction of lymph node metastasis and local recurrence in patients with rectal cancer.     

直肠癌侧方淋巴结清扫的再思考

直肠淋巴流向的研究从1895年D. Gerota的研究开始,提出了直肠淋巴流向可以分为上、中、下三个方向,经过很多学者的进一步研究修正,现普遍认为侧方淋巴流向可以分为4个方向：1.前方,由膀胱下动脉,前列腺动脉,经闭孔动脉到髂总动脉;2.沿直肠中动脉到髂内动脉;3.沿着骶中动脉和骶外侧动脉到腹主动脉分叉部位;4.沿着直肠下动脉到髂内动脉。侧方淋巴结转移主要发生在低位直肠癌,浸润深度大于肌层者,而转移的侧方淋巴结并不包括在直肠癌全直肠系膜切除术（TME）范围之内。NCCN直肠癌诊疗指南中没有提及侧方淋巴结的概念,日本大肠癌规约则认为有适应证的低位直肠癌应行侧方淋巴结清扫术。西方学者认为直肠癌侧方淋巴结转移是全身疾病,侧方淋巴结清扫难以改善总体临床结局;日本学者则认为是局部疾病,对低位直肠癌规范手术为TME＋侧方淋巴结清扫。西方学者认为术前放化疗可替代侧方淋巴结清扫;东方学者则认为对于术前放化疗不敏感的直肠癌患者,侧方淋巴结清扫术仍不失为一个可供选择的治疗方案。低位直肠癌患者是否应行预防性盆腔侧方淋巴结清扫仍存在争议,但治疗性侧方淋巴结清扫术则是日本的直肠癌规范治疗。不少研究报道了腹腔镜侧方淋巴结清扫术的初步探索结果,认为其是安全有效的,但其与开放手术的远期肿瘤学结果对比仍需多中心随机对照研究验证。     

Multivariate prognostic study on node-positive gastric cancer: is tumor size a prognostic indicator?

Background/Aims: We analyzed the clinicopathological factors of patients with node-positive gastric cancer, evaluated the prognostic factors associated with long-term survival and clarified the effect of tumor size on long-term survival. Methodology: The study included 591 patients who underwent curative resection for node-positive gastric cancer. Clinicopathological prognostic variables were evaluated as predictors of long-term survival by univariate and multivariate analyses. Results: The 5-year survival rate was influenced by tumor size, tumor location, depth on invasion, level of lymph node metastasis, Borrmann classification, histological type, liver metastasis, peritoneal dissemination and disease stage. Of these, independent prognostic factors were depth on invasion and lymph node metastasis. Tumor size is an influence but not independent factor for the prediction of long-term survival in patients with node-positive gastric cancer. Conclusions: In patients with node-positive gastric cancer, two independent prognostic factors were depth on invasion and the status of lymph node metastasis.     

Significance of para-aortic lymph node dissection in advanced gastric cancer.

BACKGROUND/AIMS: Since surgical results in advanced gastric cancer remain poor and para-aortic lymph node dissection may contribute to survival, it is useful to determine the significance of para-aortic lymph node dissection. METHODOLOGY: Para-aortic lymph node dissection was provisionally indicated for patients with invasion depth deeper than the subserosal layer. Clinicopathologic variables were retrospectively analyzed using univariate analysis and multivariate analysis to predict para-aortic lymph node metastasis. Similarly, they were analyzed using univariate analysis and the Cox's proportional hazards regression model to estimate the prognostic factor in 120 patients who underwent para-aortic lymph node dissection. Surgical results and post-operative complications were compared between para-aortic lymph node dissection and D2 dissection. RESULTS: Univariate analysis revealed that the mean diameter, the degree of lymph node metastasis, and the invasion depth were significant predictors of para-aortic lymph node metastasis. Multivariate analysis showed that n2 was the only independent predictive factor as to para-aortic lymph node metastasis. Univariate analysis revealed tumor site, tumor diameter, lymph node metastasis, number of positive lymph nodes, INF, and stage were significantly associated with 5-year survival. The Cox's proportional hazards regression model showed that the number of positive lymph nodes and the number of positive para-aortic lymph nodes were independent prognostic factors. Patients with < or = 10 positive lymph nodes in any stage or < or = 3 positive para-aortic lymph nodes in stage IVb had significantly better surgical results. Surgical results for patients who underwent para-aortic lymph node dissection with n2 or invasion depth deeper than the exposed serosa were significantly higher than those in D2. As to post-operative complications, pancreatic fistula and respiratory complications were significantly frequent after para-aortic lymph node dissection. CONCLUSIONS: n2 is helpful in predicting para-aortic lymph node metastasis. Whereas, post-operative morbidity such as pancreatic fistula and respiratory complications after para-aortic lymph node dissection were significantly higher, they were controllable. Para-aortic lymph node dissection should be indicated in advanced gastric cancer patients in which lymph node metastasis is over n2 or invasion depth is deeper than the exposed serosa. But the number of positive para-aortic lymph nodes must be less than three.     

Histopathologic characteristics of colorectal cancer with liver metastasis

PURPOSE: Although prognostic factors of colorectal cancer have been studied, factors associated with liver metastasis have not been fully investigated. The aim of this study was to clarify the histopathologic characteristics of colorectal cancer with liver metastasis. METHODS: We performed a retrospective histopathologic study on 335 patients who underwent resection of colorectal cancer during 15 years. Histopathologic parameters of tumors with liver metastasis were compared with those without liver metastasis. RESULTS: Forty-one patients (12 percent) had simultaneous liver metastasis. Tumors having liver metastasis, when compared with those not having liver metastasis, were characterized by high frequency of tumor size more than 6 cm (51vs. 28 percent;P<0.01), presence of serosal invasion (98vs. 66 percent;P<0.01), lymphatic invasion (34vs. 15 percent;P<0.01), venous invasion (24vs. 3 percent;P<0.01), and lymph node metastasis (85vs. 39 percent;P<0.01). Multivariate analysis showed that factors independently associated with liver metastasis were serosal invasion, venous invasion, and lymph node metastasis. Accuracy in the diagnosis of liver metastasis was highest for venous invasion (88 percent) and lowest for serosal invasion (41 percent). Among 98 patients with both serosal invasion and lymph node metastasis, tumors with and without liver metastasis were different in frequency of venous invasion (26vs. 6 percent;P<0.01) and extracolic lymph node metastasis (68vs. 47 percent;P<0.05). CONCLUSION: In colorectal cancer important factors associated with liver metastasis were serosal invasion, venous invasion, and lymph node metastasis. Significant determinants for liver metastasis from colorectal cancer were venous invasion and extracolic lymph node metastasis.Presented at the meeting of The Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan, July 4, 1997.     

The prognostic factors after radical esophagectomy for esophageal cancer with positive preoperative CEA

BACKGROUND/AIMS: We investigated in this paper the clinicopathological factors that affect the prognosis of esophageal cancer with preoperative positive CEA. METHODOLOGY: Out of 252 patients with thoracic esophageal cancer who received curative resection in our department, we selected 33 cases with esophageal cancer that had positive serum CEA level preoperatively. We analyzed the clinicopathological factors which affect the prognosis in these CEA positive cases. RESULTS: There were no differences in preoperative CEA levels according to the variant clinicopathological factors. The number of lymph nodes metastasis, depth of tumor involvement, lymphatic invasion, and preoperative SCC antigen level were the significant factors influencing survival. But, only preoperative SCC antigen level was independent and a significant prognostic factor on multivariant analysis. CONCLUSIONS: While sensitivities of SCC antigen and CEA are low in esophageal cancer, the cases having positive value in both CEA and SCC antigen preoperatively have high recurrence rates after radical esophagectomy.     

A case report of mucosal Barrett's cancer with vessel involvement, with special reference to indications for endoscopic mucosal ablation therapy

We present a 72-year-old female patient with mucosal Barrett's cancer. Although preoperative diagnosis suggested tumor invasion throughout the mucosal layer, she was treated by endoscopic mucosal resection at her preference. The tumor invasion depth was “m-3.” However, tumor cells were observed along the endothelium of a small vein. Following endoscopic treatment, ultimately the patient underwent radical surgery. Neither residual tumor nor lymph node metastasis was found in the resected specimens. We also reviewed published reports regarding the relationship between tumor depth and vessel involvement in early-stage Barrett's cancer. In Barrett's cancer with a tumor invasion of m-3 where tumor had invaded throughout the mucosal layer, blood or lymphatic vessel invasion was observed in 12.5% of cases (6/48). However, no lymph node metastasis was found. Therefore, we considered that endoscopic mucosal ablation therapy may be applicable to treat intramucosal Barrett's cancer with a tumor invasion depth of m-3.     

Preoperative assessment of vascularity by color Doppler ultrasonography in human rectal carcinoma

PURPOSE: Although angiogenesis assessed by immunostaining endothelial cells (microvessel density) is a well-known prognostic factor in a wide variety of human solid tumors, preoperative determination of microvessel density seems to be difficult in rectal carcinoma. Thus, we performed transanal color Doppler ultrasonography in 46 patients with rectal carcinoma to assess preoperative angiogenic status and compare it with microvessel density in surgical specimens. METHODS: Time-averaged maximal velocity, peak systolic velocity, number of vascular points, and vascular point index were conducted by color Doppler ultrasonography in 46 patients with rectal carcinoma. Number of vascular points was defined as the number of vessels with pulsation in the section of tumor. Vascular point index was defined as the average number of vascular points divided by the area assessed by color Doppler ultrasonography in the section of tumor. The profiles of number of vascular points were similar to those assessed by microangiography in five rectal carcinomas. RESULTS: Vascular point index significantly correlated with microvessel density (P<0.0001). No significant correlation was found between microvessel density and time-averaged maximal velocity or peak systolic velocity. Vascular point index was also a better indicator of lymph node metastasis and venous invasion than microvessel density. In addition, 11 of 46 cases with postoperative hematogenous metastasis (23.9 percent) were observed prospectively. Vascular point index may be a best predictor for hematogenous metastasis from rectal carcinoma compared with peak systolic velocity, time-averaged maximal velocity, and microvessel density by receiver operating characteristic analysis. CONCLUSION: These results suggest that preoperative quantification of angiogenesis using color Doppler ultrasonography will provide quick and useful information in the management of rectal carcinoma.Supported a grant from Ogura Memorial Hospital.     

Computed tomography and magnetic resonance imaging evaluation of lymph node metastasis in early colorectal cancer

AIM: To assess the role of computed tomography(CT) and magnetic resonance imaging(MRI) and establish imaging criteria of lymph node metastasis in early colorectal cancer.METHODS: One hundred and sixty patients with early colorectal cancer were evaluated for tumor location, clinical history of polypectomy, depth of tumor invasion, and lymph node metastasis. Two radiologists assessed preoperative CT and/or MRI for the primary tumor site detectability, the presence or absence of regional lymph node, and the size of the largest lymph node. Demographic, imaging, and pathologic findings were compared between the two groups of patients based on pathologic lymph node metastasis and optimal size criterion was obtained.RESULTS: The locations of tumor were ascending, transverse, descending, sigmoid colon, and rectum. One hundred and sixty early colorectal cancers were classified into 3 groups based on the pathological depth of tumor invasion; mucosa, submucosa, and depth unavailable. A total of 20(12.5%) cancers with submucosal invasion showed lymph node metastasis. Lymph nodes were detected on CT or MRI in 53 patients. The detection rate and size of lymph nodes were significantly higher(P = 0.000, P = 0.044, respectively) in patients with pathologic nodal metastasis than in patients without nodal metastasis. Receiver operating curve analysis showed that a cut-off value of 4.1 mm is optimal with a sensitivity of 78.6% and specificity of 75%.CONCLUSION: The short diameter size criterion of≥ 4.1 mm for metastatic lymph nodes was optimal for nodal staging in early colorectal cancer.     

Direct Tumor Invasion in Colon Cancer: Correlation with Tumor Spread and Survival

Purpose  This study examined the correlation between depth of local invasion in colon cancer and tumor spread and patient survival. Methods  A cohort of 796 patients with a complete set of TNM staging information following an elective resection for colon cancer was selected. The rates of lymph node and distant metastasis, tumor differentiation, and extramural venous invasion for different tumor (T) categories were compared. The effects of initial tumor (T) category on overall patient survival were studied. Results  The depth of local tumor invasion correlated strongly with nodal involvement (P = 0.0001), rates of extramural venous invasion (P = 0.0002), poor differentiation (P = 0.0001), and distant metastasis (P = 0.0001). Fifty-seven percent of the patients remained lymph node-negative and distant metastasis-negative irrespective of their depth of tumor invasion had no impact on overall survival (P = 0.49). For patients with lymph node or distant metastasis (43 percent), depth of tumor invasion had significant impact on overall survival (P = 0.001). Thirteen percent of T3N1, 33 percent of T3N2, 40 percent of T4N1, and 68.percent of T4N2 cases had distant metastasis at presentation. Conclusion  Two types of colon cancer were observed: locally active and tendency to metastasize. For the latter, overall mortality and the risk of metastasis increased with depth of tumor invasion. Reprints are not available.