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1.
Lymphatic Vessel Density at the Site of Deepest Penetration as a Predictor of Lymph Node Metastasis in Submucosal Colorectal Cancer 总被引:2,自引:0,他引:2
Kaneko I Tanaka S Oka S Kawamura T Hiyama T Ito M Yoshihara M Shimamoto F Chayama K 《Diseases of the colon and rectum》2007,50(1):13-21
Purpose Lymph node metastasis is an important factor that influences curability after endoscopic treatment of submucosal colorectal
cancer. This study was designed to determine the usefulness of identification of lymphatic vessels by immunohistochemistry
in predicting lymph node metastasis of submucosal colorectal cancer.
Methods Lymphatic involvement was assessed by hematoxylin and eosin staining and podoplanin immunostaining on samples resected from
268 patients with submucosal colorectal cancer. Lymphatic vessel density was estimated by two investigators by average count
of three fields (×200) in the area of greatest number of podoplanin-positive capillaries at the site of deepest submucosal
penetration. Relations with other clinicopathologic parameters also were investigated.
Results Lesions with high lymphatic vessel density (≥9 vessels per field) showed a significantly greater incidence of lymph node metastasis
than did those with low lymphatic vessel density (<9 vessels per field; 23.3 vs. 8.4 percent). By multivariate analysis, lymphatic vessel density was determined to be an independent risk factor for lymph
node metastasis of submucosal colorectal cancer (P = 0.0044). Lymphatic vessel density also correlated with tumor budding and the degree of inflammation at the invasive front.
Conclusions Identification of lymphatic vessels by podoplanin immunostaining provides objective and accurate evaluation of lymphatic involvement.
Lymphatic vessel density at the site of deepest penetration is a useful predictor of lymph node metastasis of submucosal colorectal
cancer.
Supported by a grant from the Japanese Society of Gastroenterological Endoscopy, Chugoku Branch.
Presented at the meeting of The Japanese Society of Gastroenterology, Kokura, Fukuoka, Japan, April 20 to 22, 2006.
Reprints are not available. 相似文献
2.
M. Ishii M. Ota S. Saito Y. Kinugasa S. Akamoto I. Ito 《International journal of colorectal disease》2009,24(9):1069-1074
Objective When selecting patients who are at high risk for lymph node metastasis, the detection of lymphatic vessel invasion (LVI) is
important. We investigated LVI detected by D2-40 staining as a predictor of lymph node metastasis in T1 colorectal cancer.
Materials and methods Clinicopathological factors including LVI were investigated in 136 patients who underwent colectomy with lymph node dissection
for T1 colorectal cancer. We used immunostaining with monoclonal antibody D2-40 to detect LVI.
Results Lymph node metastases were found in 18 patients (13.2%), and LVI were detected in 45 (33%); lymph node metastasis was more
frequently observed in LVI-positive groups (13/45 vs 5/91, p < 0.001). Both univariate and multivariate analyses revealed that LVI detected by D2-40 and a poorly differentiated histology
at the invasion front were independent risk factors of lymph node metastasis.
Conclusion LVI detected by D2-40 is important for the prediction of lymph node metastasis. 相似文献
3.
Yasuda K Inomata M Shiromizu A Shiraishi N Higashi H Kitano S 《Diseases of the colon and rectum》2007,50(9):1370-1376
Purpose Although risk factors for histologically overt lymph node metastasis in patients with early-stage colorectal cancer have been
clarified, the risk factors for occult lymph node metastasis are not clear. This study was designed to clarify risk factors
for lymph node metastasis, including occult metastasis, in patients with colorectal cancer invading the submucosa and to determine
the criteria for endoscopic resection of early colorectal cancer.
Methods The risk factors for lymph node metastasis, including occult metastasis, were analyzed in 86 cases of surgically resected
colorectal cancer invading the submucosa. The lymph nodes were assessed by immunohistochemistry with cytokeratin antibody
CAM5.2.
Results The frequencies of overt and occult metastasis to the lymph nodes were 13 percent (11/86) and 13 percent (10/75), respectively.
Multivariate analysis showed vascular invasion (P = 0.001) and tumor budding (P = 0.003) to be independent risk factors for lymph node metastasis, including occult metastasis. For tumors with submucosal
invasion ≤1,000 μm, no lymph node metastasis was found. The frequencies of lymph node metastasis for tumors with submucosal
invasion of 1,000 to 2,000 μm and >2,000 μm were 21 and 37 percent, respectively. In considering combinations of risk factors,
there was no lymph node metastasis in tumors having neither vascular invasion nor tumor budding and submucosal invasion of
≤3,000 μm.
Conclusions Vascular invasion, tumor budding, and the degree of submucosal invasion were significant risk factors for lymph node metastasis,
including occult metastasis. These three factors can be used in combination to identify patients requiring additional surgery
after endoscopic resection.
Supported in part by a Grant-in-Aid for Scientific Research (no. 15390401) from the Japanese Ministry of Education, Science,
and Culture.
Presented at the Congress of Japan Surgery Society, Tokyo, Japan, March 29 to 31, 2006.
Reprints are not available. 相似文献
4.
Immunohistochemical molecular markers as predictors of curability of endoscopically resected submucosal colorectal cancer 总被引:5,自引:0,他引:5
Kaneko I Tanaka S Oka S Yoshida S Hiyama T Arihiro K Shimamoto F Chayama K 《World journal of gastroenterology : WJG》2007,13(28):3829-3835
AIM: To clarify the usefulness of immunohistochemical molecular markers in predicting lymph node metastasis of submucosal colorectal cancer.
METHODS: We examined microvessel density, lymphatic vessel density, the Ki-67 labeling index, expression of MUC1 and Matrix metalloproteinase-7 (MMP-7) in tumor cells, and expression of cathepsin D in stromal cells at the invasive front by immunostaining of samples resected from 214 patients with submucosal colorectal cancer. Pathologic features were assessed on hematoxylin-eosinstained samples. We evaluated the relations between clinicopathologic/immunohistochemical features and lymph node metastasis.
RESULTS: Lesions of the superficial type, with an unfavorable histologic grade, budding, lymphatic involvement, high microvessel density (≥ 40), high lymphatic vessel density (≥9), high Ki-67 labeling index (≥ 42), and positivity of MUC1, cathepsin D, and MMP-7 showed a significantly high incidence of lymph node metastasis. Multivariate analysis revealed that high microvessel density, unfavorable histologic grade, cathepsin D positivity, high lymphatic vessel density, superficial type, budding, and MUC1 positivity were independent risk factors for lymph node metastasis.A combined examination with four independent immunohistochemical markers (microvessel density, cathepsin D, lymphatic vessel density, and MUC1) revealed that all lesions that were negative for all markers or positive for only one marker were negative for lymph node metastasis.
CONCLUSION: Analysis of a combination of immuno- histochemical molecular markers in endoscopically resected specimens of submucosal colorectal cancer allows prediction of curability regardless of the pathologic features visible of hematoxylin-eosin-stained sections. 相似文献
METHODS: We examined microvessel density, lymphatic vessel density, the Ki-67 labeling index, expression of MUC1 and Matrix metalloproteinase-7 (MMP-7) in tumor cells, and expression of cathepsin D in stromal cells at the invasive front by immunostaining of samples resected from 214 patients with submucosal colorectal cancer. Pathologic features were assessed on hematoxylin-eosinstained samples. We evaluated the relations between clinicopathologic/immunohistochemical features and lymph node metastasis.
RESULTS: Lesions of the superficial type, with an unfavorable histologic grade, budding, lymphatic involvement, high microvessel density (≥ 40), high lymphatic vessel density (≥9), high Ki-67 labeling index (≥ 42), and positivity of MUC1, cathepsin D, and MMP-7 showed a significantly high incidence of lymph node metastasis. Multivariate analysis revealed that high microvessel density, unfavorable histologic grade, cathepsin D positivity, high lymphatic vessel density, superficial type, budding, and MUC1 positivity were independent risk factors for lymph node metastasis.A combined examination with four independent immunohistochemical markers (microvessel density, cathepsin D, lymphatic vessel density, and MUC1) revealed that all lesions that were negative for all markers or positive for only one marker were negative for lymph node metastasis.
CONCLUSION: Analysis of a combination of immuno- histochemical molecular markers in endoscopically resected specimens of submucosal colorectal cancer allows prediction of curability regardless of the pathologic features visible of hematoxylin-eosin-stained sections. 相似文献
5.
Wong SK Jalaludin BB Henderson CJ Morgan MJ Berthelsen AS Issac MM Kneebone A 《Diseases of the colon and rectum》2008,51(9):1331-1338
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. 相似文献
6.
Curative Resection of T1 Colorectal Carcinoma: Risk of Lymph Node Metastasis and Long-Term Prognosis 总被引:9,自引:1,他引:9
Wang HS Liang WY Lin TC Chen WS Jiang JK Yang SH Chang SC Lin JK 《Diseases of the colon and rectum》2005,48(6):1182-1192
PURPOSE The features of T1 colorectal adenocarcinoma and the risk determination of lymph node metastasis were reviewed. Prognostic factors were assessed to verify whether the risk of lymph node metastasis would influence the long-term prognosis.METHODS Patients undergoing curative resection of T1 colorectal adenocarcinoma at the Taipei Veterans General Hospital from December 1969 to August 2002 were retrospectively studied. Patients with synchronous colorectal cancer, distant metastasis, familiar adenomatous polyposis, or inflammatory bowel disease were excluded. The associations between lymph node metastasis and clinicopathologic variables were evaluated univariately using chi-squared test, Fisher’s exact test, or Student’s t -test, and multivariately using logistic regression. Univariate analysis by the log-rank test and multivariate analysis by Cox regression hazards model determined the factors influencing the overall survival.RESULTS A total of 159 patients were included. Sixteen patients (10.1 percent) had lymph node metastasis. The risk of lymph node metastasis included histologic grade (P = 0.005), lymphatic vessel invasion (P = 0.023), inflammation around cancer (P = 0.049), and budding at the invasive front of tumor (P = 0.022). Age (P = 0.001) and number of total sampling lymph nodes (P < 0.0001) were found to be the factors influencing the overall survival.CONCLUSIONS Variables that predict lymph node metastasis in surgically resected T1 colorectal carcinoma may not impact the long-term prognosis.Supported by a grant from the Research Foundation of Taipei Veterans General Hospital. 相似文献
7.
Zhen-Jun Li Xiao-Jiang Ying Hong-Liang Chen Ping-Jiang Ye Zhi-Liang Chen Gang Li Hua-Feng Jiang Jiang Liu Shu-Zhen Zhou 《World journal of gastroenterology : WJG》2013,19(43):7788-7794
AIM:To investigate the expression of insulin-like growth factor-1(IGF-1)/insulin-like growth factor-1 receptor(IGF-1R)in colorectal cancer(CRC)tissues and to analyze their correlation with lymphangiogenesis and lymphatic metastasis.METHODS:Immunohistochemistry was used to evaluate IGF-1 and IGF-1R expression and lymphatic vessel density(LVD)in 40 CRC specimens.The correlation between IGF-1/IGF-1R and LVD was investigated.Effects of IGF-1 on migration and invasion of CRC cells were examined using transwell chamber assays.A LoVo cell xenograft model was established to further detect the role of IGF-1 in CRC lymphangiogenesis in vivo. RESULTS:Elevated IGF-1 and IGF-1R expression in CRC tissues was correlated with lymph node metastasis(r=0.715 and 0.569,respectively,P<0.05)and tumor TNM stage(r=0.731 and 0.609,P<0.05).A higher LVD was also found in CRC tissues and was correlated with lymphatic metastasis(r=0.405,P<0.05).A positive correlation was found between LVD and IGF-1R expression(r=0.437,P<0.05).Transwell assays revealed that IGF-1 increased the migration and invasion of CRC cells.In vivo mouse studies showed that IGF-1 also increased LVD in LoVo cell xenografts.CONCLUSION:IGF-1/IGF-1R signaling induces tumorassociated lymphangiogenesis and contributes to lymphatic metastasis of CRC. 相似文献
8.
Kim JH Cheon JH Kim TI Baik SH Kim NK Kim H Kim WH 《Digestive diseases and sciences》2008,53(11):2941-2946
The aim of this study was to determine the need for additional treatment following endoscopic mucosal resection for early
colorectal cancer. Risk factors for residual carcinoma were investigated using specimens of curative surgical resection performed
after endoscopic mucosal resection. A total of 44 patients who had received imperfect endoscopic mucosal resection initially
for early colorectal cancers and, therefore, had undergone subsequent surgical resection were enrolled in this study. Of
these, 39 (88.6%) were resected completely by endoscopic mucosal resection based on gross inspection, while the other five
cases (11.4%) were incompletely resected. Histopathological examination of specimens of endoscopic mucosal resection revealed
that microscopic lateral resection margin was positive in 11 cases (25.0%) and vertical resection margin was positive in 16
cases (36.4%). However, after curative surgery, residual cancer within colorectal tissue was found in only five cases (11.4%),
while lymph node metastases were found in three cases (6.8%). Gross incomplete resection (P < 0.001) and microscopic vertical margin positivity (P = 0.031) were found to be risk factors of residual cancer within the colorectal tissue, whereas lymphovascular invasion was
a risk factor for lymph node metastasis (P = 0.040). However, no residual cancer cells were found after supplementary surgery in the microscopic lateral resection margin-positive
cases. In conclusion, grossly incomplete resection, microscopic vertical resection margin positivity, or the presence of lymphovascular
invasion after endoscopic mucosal resection for early colorectal cancer indicate the need for further treatment with surgical
resection and lymph node dissection. However, microscopic lateral margin positivity without gross remnant tumor and deep submucosal
invasion might not indicate residual cancer. This needs to be further validated by a large scale, prospective study with long-term
follow-up. 相似文献
9.
Tsujitani S Saito H Honboh T Ataka M Tanida T Makino M Ikeguchi M 《Diseases of the colon and rectum》2007,50(8):1241-1249
Purpose This study was designed to assess the prognostic value of receptor-binding cancer antigen expressed on SiSo cells expression
and its relationship with cadherin expression in patients with colorectal cancer.
Methods The expressions of receptor-binding cancer antigen expressed on SiSo cells and E-cadherin were analyzed with special reference
to prognosis in 105 patients with colorectal cancer.
Results Receptor-binding cancer antigen expressed on SiSo cells immunoreactivity was detected in the membrane and cytoplasm of tumor
cells and considered to be positive in 48 patients (45.7 percent). The expression of receptor-binding cancer antigen expressed
on SiSo cells was significantly correlated with lymph node metastasis (P = 0.0004), venous invasion (P = 0.0062), Dukes stages (P < 0.0001), and serum levels of carcinoembryonic antigen (P = 0.014). Furthermore, receptor-binding cancer antigen expressed on SiSo cells expression was significantly correlated with
a poor prognosis (P < 0.001), and multivariate analysis indicated that it was an independent prognostic indicator. The expression of receptor-binding
cancer antigen expressed on SiSo cells was more frequently found in tumors with reduced or abnormal expression of E-cadherin.
The survival time of patients with reduced/abnormal E-cadherin expression was significantly shorter than that of patients
with normal E-cadherin expression among patients with receptor-binding cancer antigen expressed on SiSo cells expression (P = 0.0043) but did not differ for those without receptor-binding cancer antigen expressed on SiSo cells expression (P = 0.17). Furthermore, multivariate analysis revealed that reduced/abnormal expression of E-cadherin was an independent prognostic
factor in patients with receptor-binding cancer antigen expressed on SiSo cells expression but not in those without receptor-binding
cancer antigen expressed on SiSo cells expression.
Conclusions Receptor-binding cancer antigen expressed on SiSo cells expression is significantly correlated with tumor progression and
poor prognosis in patients with colorectal cancer. Both reduced E-cadherin and enhanced receptor-binding cancer antigen expressed
on SiSo cells expression may be critical for the mechanism of metastasis and recurrence in human colorectal cancer. 相似文献
10.
大肠癌组织中生长抑素和血管内皮生长因子-C的表达及其临床意义 总被引:4,自引:1,他引:4
目的探讨大肠癌组织中生长抑素(SS)和血管内皮生长因子-C(VEGF-C)的表达及其临床意义。方法采用免疫组化法检测60例大肠癌组织及20例正常大肠黏膜组织中SS蛋白和VEGF-C蛋白的表达,采用VEGF-C受体FLT-4阳性脉管标记淋巴管计数,分析SS与大肠癌淋巴管生成、转移的关系。结果SS蛋白表达阳性率在大肠癌组及正常大肠黏膜组分别为37.7%和65%,VEGF-C在癌及正常组阳性表达率分别为60%和30%,差别均有显著性;SS表达与肿瘤分化程度、淋巴结转移、淋巴管侵犯及远处转移密切相关,与浆面膜受累无关;VEGF-C表达与肿瘤淋巴结转移,淋巴管侵犯及远处转移密切相关,而与肿瘤分化和浆面膜受累无关;大肠癌组织中SS和VEGF-C蛋白表达呈显著负相关。结论SS可能通过对VEGF-C/FLT-4信号通路的阻滞而抑制大肠癌淋巴管生成及转移。 相似文献
11.
Dr. Yosuke Adachi M.D. Masafumi Inomata M.D. Kenji Kakisako M.D. Koichi Sato M.D. Norio Shiraishi M.D. Seigo Kitano M.D. 《Diseases of the colon and rectum》1999,42(8):1053-1056
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. 相似文献
12.
Expression of vascular endothelial growth factor-C and the relationship between lymphangiogenesis and lymphatic metastasis in colorectal cancer 总被引:8,自引:0,他引:8
Jia YT Li ZX He YT Liang W Yang HC Ma HJ 《World journal of gastroenterology : WJG》2004,10(22):3261-3263
AIM: To investigate the expression of vascular endothelial growth factor-C (VEGF-C) and the relationship between VEGF-C and lymphangiogenesis, lymph node metastasis in colorectal cancer. METHODS: Fifty six cases of colorectal cancer were selected randomly. Expression of VEGF-C was detected by immunohistochemistry, and lymphatic vessels were stained by enzyme histochemical method. RESULTS: VEGF-C expression was found in 66.7% (37/56) patients. In VEGF-C positive and negative patients, the lymphatic vessel density was 25.16+/-7.52 and 17.14+/-7.22, respectively (P<0.05). The rate of lymph node metastasis in VEGF-C positive patients (81.1%) was significantly higher than that in the negative group (42.1%). CONCLUSION: VEGF-C expression may induce lymphangiogenesis in colorectal cancer, as a result, tumor cells can entry the lymphatic vessels easily. VEGF-C may serve as a useful prognotic factor in colorectal carcinoma. 相似文献
13.
Location of Early Colorectal Cancers at Fold-Top May Reduce the Risk of Lymph Node Metastasis 总被引:1,自引:0,他引:1
Pan W Terai T Abe S Sakamoto N Nagahara A Ohkusa T Ogihara T Sato N 《Diseases of the colon and rectum》2006,49(5):579-587
Purpose This study was designed to look for significant correlations between location of early colorectal cancer, distance from muscularis
mucosae to muscularis propria, and the frequency of lymph node metastasis.
Methods A total of 166 early colorectal cancers, including 67 surgically resected lesions, were evaluated. The cancers were divided
into two groups: metastatic and nonmetastatic. Cancer lesions were further subtyped at the fold-top or fold-bottom. Macroscopic
classifications and histology were performed. Absolute invasive depth and distance from muscularis mucosae to muscularis propria
was measured. Multivariate analysis was used to assess relationships among the variables.
Results The percentage of polypoid cancer lesions at fold-bottom was higher than at fold-top (74.5 vs. 51.8 percent), whereas flat-type cancer lesions at fold-bottom occurred less often than at fold-top (8.2 vs. 30.4 percent). Logistic regression showed that deep absolute invasive depth, lymphatic and vessel invasion, and cancer location
(at fold-bottom) were the significant risk factors for early colorectal cancers leading to lymph-node metastasis. The distance
from muscularis mucosae to muscularis propria with lymph-node metastasis (1,396.7 ± 728.4 μm) was shorter than without lymph-node
metastasis (3,533.9 ± 2,507.8 μm; P < 0.01). Multivariate analysis showed that distance from muscularis mucosae to muscularis propria was a statistically significant
factor for early colorectal cancers leading to lymph node metastasis (P = 0.0054).
Conclusions We conclude that early colorectal cancers at the fold-top or with a long distance from muscularis mucosae to muscularis propria
have less tendency to metastasize to lymph nodes. Clinically, these results provide evidence of a new indicator of endoscopic
mucosal resection for early colorectal cancers at the fold-top. 相似文献
14.
Predictive Histopathologic Factors for Lymph Node Metastasis in Patients With Nonpedunculated Submucosal Invasive Colorectal Carcinoma 总被引:4,自引:3,他引:4
Tominaga K Nakanishi Y Nimura S Yoshimura K Sakai Y Shimoda T 《Diseases of the colon and rectum》2005,48(1):92-100
PURPOSE Risk factors for lymph node metastasis in patients with nonpedunculated submucosal invasive colorectal carcinoma remain to be characterized. This study examines the relationship between lymph node metastasis and clinicopathologic factors in nonpedunculated submucosal invasive colorectal carcinoma.METHODS The study cohort comprised 155 patients who had undergone surgical treatment for nonpedunculated submucosal invasive colorectal carcinoma. The clinicopathologic factors investigated included gender, age, tumor location, macroscopic type, tumor size, histologic type and grade, intramucosal growth pattern, lymphatic invasion, venous invasion, degree of focal dedifferentiation at the submucosal invasive front, status of the remaining muscularis mucosa, and the depth and width of submucosal invasion.RESULTS Lymph node metastases were found in 19 patients (12.3 percent). Univariate analysis showed that lymphatic invasion, focal dedifferentiation at the submucosal invasive front, status of the remaining muscularis mucosa, and depth of submucosal invasion all had a significant influence on lymph node metastasis. Multivariate analysis showed lymphatic invasion (P = 0.014) and high-grade focal dedifferentiation at the submucosal invasive front (P = 0.049) to be independent factors predicting lymph node metastasis. No lymph node metastasis was found in tumors with a depth of submucosal invasion of <1.3 mm.CONCLUSIONS Lymphatic invasion and high-grade focal dedifferentiation at the submucosal invasive front are important predictors of lymph node metastasis in patients with nonpedunculated submucosal invasive colorectal carcinoma. Depth of submucosal invasion can be used as an identifying marker for patients who do not require subsequent surgery after endoscopic resection.Supported in part by a grant-in-aid for cancer research from the Ministry of Health and Welfare of Japan. 相似文献
15.
Podoplanin expression in advanced-stage gastric carcinoma and prognostic value of lymphatic microvessel density 总被引:4,自引:0,他引:4
In gastric cancer, lymph node metastasis is a major prognostic factor. Tumor lymphangiogenesis promotes metastasis in experimental models, but in human tumors data about the presence and clinical significance of lymphatic vessels in the tumor area are controversial. We investigated 70 patients with advanced-stage gastric carcinoma and the pathological examination showed 40 cases with intestinal subtype and 30 cases with diffuse subtype. Forty three from 70 cases had regional lymph node metastasis. Additional slides were stained with an antibody against podoplanin, and lymphatic microvessel density (LMVD) was evaluated in the tumoral and peritumoral areas. Lymphatic vessels were identified in tumor area in all cases and LMVD was higher in the peritumoral than in the tumor area. Podoplanin-positive vessels in tumor area were usually small, with narrow lumen. A significant correlation was found between LMVD and stage of the tumor (p<0.002) and lymph node metastasis (p<0.031), but not with the pathological subtype and grade of the tumor. We found tumor cells in the lumen of lymphatic vessels in 11 cases, whereas tumor cells expressing podoplanin were found in 4 cases of less differentiated diffuse subtype gastric carcinoma. In conclusion, our results suggest that LMVD predicts tumor stage and lymph node metastasis, and podoplanin-positive tumor cells select a subgroup of tumors with high potential of invasion and metastasis. Key words: gastric cancer, podoplanin, lymphatic microvessel density (LMVD), lymphangiogenesis, prognosis. 相似文献
16.
KENTARO KAWASAKI YOSHITAKE HAYASHI YAO WANG SATOSHI SUZUKI YASUSHI MORITA TAKESHI NAKAMURA KOICHI NARITA WILLIAM DOE HIROSHI ITOH YOSHIKAZU KURODA 《Journal of gastroenterology and hepatology》1998,13(9):936-944
In gastric cancer, the urokinase-type plasminogen activator (uPA) system plays important roles in invasion and metastasis, processes which entail proteolysis and adhesion. Both the urokinasetype plasminogen activator receptor (uPAR) and the plasminogen activator inhibitor-1 (PAI-1) are thought to be important factors in this system. To clarify the relationship between these two factors and gastric cancer invasiveness, we evaluated the expression of uPAR and PAI-1 in 91 cases of gastric cancer by immunohistochemistry and in situ hybridization. Urokinase-type plasminogen activator receptor-mRNA, PAI-1-mRNA, uPAR and PAI-1 protein were diffusely distributed in the cytoplasm of the cancer cells and concentrated at invasive foci. Urokinase-type plasminogen activator receptor protein expression correlated with lymphatic, venous invasion (P<.01) and lymph node metastasis (P<0.05); uPAR-mRNA expression correlated with lymphatic, venous invasion and lymph node metastasis (P<0.05). Plasminogen activator inhibitor-1 protein expression correlated with lymphatic, venous invasion, lymph node metastasis and depth of invasion (P<0.01); PAI-1-mRNA expression was linked to lymphatic, venous invasion (P<0.01), lymph node metastasis and depth of invasion (P<0.05). This suggests that the proteolytic activity of uPAR and the cellular motility of PAI-1 in gastric cancer cells may determine penetration of lymphatic and blood vessels, whereby lymph node metastasis may be promoted and that the promotion of cellular motility by PAI-1 may influence the depth of cancer invasion. 相似文献
17.
Tsai HL Yeh YS Yu FJ Lu CY Chen CF Chen CW Chang YT Wang JY 《International journal of colorectal disease》2009,24(2):177-183
Background and aim The aim of this retrospective study was to determine which clinicopathological factors influenced the incidence of postoperative
relapse and overall survival rates after radical resection of T2-4N0M0 colorectal cancer (CRC) patients via harvesting a minimum of 12 lymph nodes.
Materials and methods Between January 2001 and June 2006, a total of 342 T2-4N0M0 CRC patients who underwent radical resection were retrospectively analyzed in Kaohsiung Medical University Hospital. Of these
342 patients, 155 were observed by harvesting a minimum of 12 lymph nodes. These 155 patients were followed up intensively,
and their outcomes were investigated retrospectively.
Results Of 155 patients, 83 were men (53.5%) and 72 (46.5%) were women. The mean age was 65.5 ± 11.1 years (range, 24–89 years). The
median follow-up period was 49 months (range, 19–80 months). The present data showed invasive depth (P = 0.012), vascular invasion (P < 0.001), and perineural invasion (P = 0.009) as significantly prognostic factors for postoperative 5-year relapse rate by Kaplan–Meier analysis. Likewise, invasive
depth (P = 0.013), vascular invasion (P < 0.001), and perineural invasion (P = 0.008) were significant factors for postoperative 5-year survival rate. Meanwhile, using a Cox proportional hazards analysis,
depth of tumor invasion (P = 0.026) and vascular invasion (P = 0.001) were the independent predictors for postoperative relapse. Furthermore, the presence of vascular invasion was considerably
correlated to the higher postoperative relapse rate and the poorer overall survival rates by survival analyses (P < 0.0001).
Conclusions Besides the conventional depth of tumor invasion, this study highlights the potential for using vascular invasion as a means
of identifying a subgroup of T2-4N0M0 CRC patients with adequate lymph node harvest at higher risk who would potential benefit from adjuvant therapy after surgery. 相似文献
18.
Predictive value of histology at the invasive margin in the prognosis of early invasive colorectal carcinoma 总被引:8,自引:0,他引:8
To accurately select patients with malignant colorectal polyps who are at high risk of adverse outcome, we examined the predictive
value of clinicopathological factors, with special attention paid to the histology at the invasive margin. We examined 75
submucosal carcinomas from 75 patients, initially resected by polypectomy, including endoscopic, trans-anal, trans-sacral,
and trans-sphincteric local excision. The associations between clinicopathological features such as sex and age; tumor size,
location, shape, depth of submucosal invasion, vascular invasion, histology at the central part, and histology at the invasive
margin; and the presence or absence of a residual adenomatous component and adverse outcome were examined by univariate and
multivariate logistic regression analyses. Lymph node metastases were found in 2 patients, local recurrence in 4, and distant
metastases in 2. Univariate logistic regression analysis showed that unfavorable histology at the invasive margin was significantly
associated with lymph node metastasis or local recurrence (P = 0.0373), whereas the association of lymphatic invasion and vascular (lymphatic or venous) invasion with lymph node metastasis
or local recurrence had marginal significance (P = 0.0785; P = 0.0990). Multivariate logistic regression analysis, with unfavorable histology at the invasive margin and lymphatic invasion
as independent variables, showed that unfavorable histology alone had significance (P = 0.0373) in predicting adverse outcome. Widely accepted criteria such as massive submucosal invasion, positive vascular
invasion, and poorly differentiated histology, were less useful in predicting adverse outcome. These results suggest that
unfavorable histology at the invasive margin is a useful risk factor for predicting lymph node metastasis or local recurrence
in patients with malignant colorectal polyps.
Received: March 23, 1999 / Accepted: August 27, 1999 相似文献
19.
The aims of this study were to examine Li-cadherin expression in 74 gastric carcinoma tissues, 10 cases with normal gastric
tissues, and 21 cases with intestinal metaplasia and to investigate the role of Li-cadherin in cell differentiation, cancer
invasion, and metastasis. Expression of Li-cadherin was analyzed by immunohistochemistry and semiquantitative polymerase chain
reactio and correlated with clinicopathological parameters. Immunohistochemistry showed that Li-cadherin was mainly present
on the cell membrane and there was no staining for liver–intestine cadherin in normal tissues. The reduction of Li-cadherin
mRNA expression was inversely correlated with the grade of differentiation (P < 0.05). Significant differences in the expression of liver–intestine cadherin were found in lymphatic metastasis of the
tumors (P < 0.05), but the expression of liver–intestine cadherin was not associated with gender (P=0.748), serosal invasion (P=0.136), TNM stage (P=0.172), Helicobacter pylori infection (P=0.572), liver metastasis (P=0.374), or peritoneal metastasis (P=0.621). Multivariate analysis revealed that the expression of Li-cadherin is an important predictor of lymph node metastasis.
We conclude that there is a significant correlation between Li-cadherin expression and the differentiation of gastric carcinoma,
and Li-cadherin can be a good marker to detect gastric cancer at early stages. Increased Li-cadherin expression may contribute
to gastric cancer invasion to lymph nodes. 相似文献
20.
目的研究新生淋巴管在胰腺导管腺癌周围神经丛微转移过程中的作用与机制。方法收集2005年9月至2006年10月长海医院行胰腺癌扩大根治术的30例胰腺导管腺癌患者的临床资料,术中采集胰腺肿瘤、癌旁、胆管下段、胰尾、肠系膜上动脉(SMA)旁组织(含胰周神经丛)以及区域淋巴结标本。常规病理检查,采用双重免疫组化方法检测毛细淋巴管,计算淋巴管密度(LVD)。结果胰内和(或)胰周神经丛浸润25例(83.3%),其中胰内合并胰周神经丛浸润20例,单纯胰内神经浸润5例,无单纯胰周神经丛浸润病例。神经浸润与患者年龄、性别、淋巴结转移、肿瘤大小、肿瘤部位无明显相关性(P〉0.05),但与JPS临床分期相关(P〈0.05)。癌组织内的平均LVD为每视野(4.2±3.4)个,显著少于癌旁的(11.3±6.9)个及正常胰腺组织的(10.8±4.4)个(P〈0.01),正常胰腺组织与癌旁组织平均LVD值差异无统计学意义。18例胰腺癌患者在非癌组织清晰可见肿瘤浸润淋巴管,而且胰周神经丛浸润与淋巴管肿瘤浸润间亦有明显相关性(P〈0.05)。结论胰腺导管腺癌周围神经丛浸润的发生率较高,神经浸润与JPS临床分期、淋巴管浸润有明显相关性,提示胰腺导管腺癌存在通过新生淋巴管途径扩散转移的可能性。 相似文献