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。     

淋巴结转移阴性结直肠癌患者的预后因素分析

目的探讨淋巴结转移阴性结直肠癌患者临床病理特点与预后的相关性,为临床治疗提供依据。方法选择116例同期行结肠癌根治术、术后检取12个以上淋巴结均无转移患者为研究对象,随访观察1、3、5 a生存率,并对可能影响预后的临床病理指标采用Kaplan-Meier法行单因素分析、采用Cox比例风险模型行多因素分析。结果单因素分析表明肿瘤大小、浸润深度和组织分化程度与预后有显著相关性（P〈0.05）;多因素分析表明术前癌胚抗原（CEA）水平、肿瘤大小和浸润深度为结直肠癌的独立预后因素（P〈0.05）。结论术前CEA水平和浸润深度可影响淋巴结转移阴性结直肠癌患者的预后,据此制定规范化个体治疗方案有望提高患者的生存率。     

结直肠癌淋巴结的分期

目的:分析结直肠癌淋巴结转移状况与预后的关系,提出新的结直肠癌淋巴结分期方案.方法:122例病理资料完整的结直肠癌病例,比较不同删分期(AJCC/UICC)病例的5年生存率:将淋巴结转移数目≥10枚和顶端淋巴结转移拟定为N,期,比较AJCC/UICC的TNM分期中No、N1、N2与N3期病例的5年生存率;按Kaplan-Meier方法计算生存率,绘制生存曲线,并对生存率进行Log-rank检验.结果:随着TNM分期的上升,5年生存率逐渐下降(Ⅰ期为100%;Ⅱ期为81.82%;ⅢAB期为69-39%,ⅢC期为15%:Ⅳ期为0,P<0.01),随着N分期的上升,5年生存率也逐渐下降(N0Ⅰ期为100%、N0Ⅱ期为89.82%、N1期69.39%,N2期为15%,P<0.01).N3期病例5年生存率为0,与TNM的Ⅳ期预后相似.结论:建议将结直肠癌TNM中的N分期定为:无淋巴结转移为N0,1-3枚淋巴结转移为N1,4-9枚淋巴结转移为N2,≥10枚淋巴结转移和/或顶端淋巴结转移为N3.N3期患者的5年生存率为0,与M1期结果相似,可以定为亚临床转移.     

血管内皮生长因子与结直肠癌淋巴结转移的研究进展

结直肠癌淋巴结转移是最主要的扩散途径,在结直肠癌的转移方式中占有重要地位,与局部复发和预后密切相关.尽管淋巴转移的现象已发现上百年,但癌细胞进入淋巴系统并生存、增殖的机制仍不清楚.     

血管内皮抑素抑制淋巴管生成和淋巴结转移的作用机制

淋巴结转移是恶性肿瘤进展的标志之一,越来越多的证据认为肿瘤新生淋巴管形成和淋巴结转移之间有密切关系。了解调节淋巴结转移和淋巴管生成的信号通路,有可能成为抑制肿瘤生长的新方法。近年来,陆续有报道认为血管内皮抑素（endostatin,ES）有抑制肿瘤新生淋巴管生成和淋巴结转移的作用,但其机制尚未完全明确。现将相关研究进展作一综述。     

淋巴结转移度预测老年结直肠癌患者术后远处转移的价值

目的探讨淋巴结转移度(LNR)对老年结直肠癌患者术后远处转移的预测价值。方法选取2011年1月至2015年1月于该院普通外科行根治性手术的老年结直肠癌患者96例,按照有无术后远处转移将入组患者分为实验组(转移组,36例)和对照组(非转移组,60例),按照LNR水平高低将入组患者分为HLNR组和LLNR组,统计分析LNR的相关临床病理因素,单因素及多因素分析影响老年结直肠癌出现术后远处转移的临床病理因素,总结分析LNR与老年结直肠癌患者出现术后远处转移相关性。结果 HLNR组和低LLNR组在年龄、大体类型和分化程度等方面均有统计学差异(均P<0.05);Logistic多因素分析结果显示,大体类型及分化程度与老年结直肠癌LNR水平独立相关(均P<0.05)。实验组和对照组在大体类型、分化程度、淋巴结检出总数(ELN)及LNR等方面均有统计学差异(均P<0.05),Logistic多因素分析结果显示:LNR、分化程度及大体类型与老年结直肠癌患者术后远处转移独立相关(RR:2.098;CI%:1.050~4.192;P<0.05)。结论 LNR、分化程度及大体类型与老年结直肠癌术后远处转移独立相关,可联合预测老年结直肠癌术后远处转移情况。     

整合素β3表达与结直肠癌淋巴结转移的相关性

目的探讨结直肠癌患者肺转移重要的血管内皮细胞标志物整合素β3（ITGB3）表达与结直肠癌转移之间的相关性。 方法采用免疫组织化学染色法检测49例原发性结直肠癌患者癌组织、癌旁正常肠黏膜组织以及相应淋巴结组织中ITGB3的表达。其中37例患者有淋巴结转移。分析ITGB3表达与患者结直肠癌转移的相关性。 结果免疫组化染色结果显示,ITGB3主要在原发性结直肠癌组织、癌旁正常肠黏膜细胞质以及相应淋巴结的间质中表达。ITGB3在不同组织的表达不同,在癌组织中的表达低于癌旁正常肠黏膜组织,且差异有统计学意义（P<0.01）;有淋巴结转移患者淋巴结ITGB3表达高于无淋巴结转移患者,且差异有统计学意义（P<0.001）。淋巴结上皮细胞ITGB3的表达与淋巴结间质组织的表达呈正相关（r=0.395,P=0.005）;且有淋巴结转移患者癌组织上皮细胞ITGB3表达与淋巴结上皮细胞ITGB3表达呈正相关（r=0.514,P=0.001）。ITGB3在淋巴结表达、上皮细胞表达以及间质表达均与淋巴结转移呈正相关（r=0.659,P<0.0001;r=0.661,P<0.0001;r=0.354,P=0.013）。 结论ITGB3淋巴结表达与结直肠癌淋巴结转移呈正相关。ITGB3可能是原发性结直肠癌患者淋巴结转移的潜在分子标志物。     

直肠癌肺淋巴管转移一例

正肺外癌性淋巴管炎为呼吸科少见病例,其临床表现可有咳嗽、咳痰、气短、喘息,体征可伴有双肺呼吸音降低、弥散干啰音。典型的CT表现为:(1)小叶间隔不均匀增厚;(2)支气管血管束增粗;(3)胸膜增厚/病变多见;(4)肺外癌性淋巴管炎多不伴有肺门淋巴结肿大。由于该病通常易被误诊为肺间质感染、心源性肺水肿、淋巴管结核等[1],因此现将我院收治的1例肺外癌性淋巴管炎患者治疗情况报道如下,以加强呼吸科同仁对该病的认识。     

结直肠癌淋巴微转移的判定及相关因素分析

目的探讨结直肠癌患者淋巴结微转移灶的特点及与临床病理参数间的关系。方法收集2010年1月至2014年1月我院收治的65名结直肠癌患者的临床资料,对其淋巴结进行免疫组化检测,分析微转移灶与临床病理特征间的相关性。结果对65例结直肠癌患者的624枚淋巴结进行了CK19及CEA免疫组化染色。结果显示:淋巴结阳性表达率为21.79%(136/624),52.31%(34/65)的患者淋巴结呈阳性表达;CK19阳性表达率为15.54%(97/624),46.15%(30/65)的患者淋巴结染色为阳性;CEA阳性表达率为20.19%(126/624),47.69%(31/65)的患者淋巴结染色为阳性。淋巴结CK19及CEA阳性表达与肿瘤大小相关(P0.05),而与年龄、性别、肿瘤部位、TNM分期、分化程度及有无血管浸润无显著相关性(P0.05)。结论免疫组化方法是检测结直肠癌微转移的有效手段,结直肠癌的微转移的发生与有无淋巴结浸润及肿瘤大小相关。     

结直肠癌转移相关信号通路

结直肠癌(CRC)是一种常见的恶性肿瘤,其转移机制已成为目前的研究热点,研究发现有多种信号通路参与调控CRC转移的调控。该文就参与调控CRC转移的相关信号通路作一综述,主要包括转化生长因子-β/Smad信号通路、PI3K/Akt信号通路、Wnt/β-连环素信号通路及整合素激活FAK介导的信号通路。     

T2大肠癌淋巴结转移的相关临床病理因素

目的:探讨与T2期大肠癌淋巴结转移密切相关的临床病理因素,为其合理高效的个体化治疗提供指标.方法:收集1991-01/2006-08中国医科大学附属第一医院肿瘤外科行根治性手术的T2期大肠癌患者324例,回顾性分析其各临床病理因素与淋巴结转移的关系.结果: 肿瘤浸润深度(OR =3.841,95% CI: 1.581-9.329,P = 0.003)与组织分型(OR = 1.451,95% CI: 1.059-1.989,P = 0.023)是影响T2大肠癌淋巴结转移的主要因素.尤其是肿瘤浸及固有肌层上1/2即浅肌层(mp1)和下1/2即深肌层(mp2),淋巴结转移率差异显著.而性别、年龄、肿瘤部位、肿瘤大小、生长方式和淋巴管及血管浸润等因素与淋巴结转移的相关性不显著.结论:肿瘤的浸润深度及组织学类型是影响T2大肠癌淋巴结转移的主要因素.其中浸润深度尤为重要,可将mp1视为一道阻止癌细胞转移播散的屏障,一旦超过mp1水平,淋巴结转移风险将显著增加.     

The risk of lymph node metastasis in T1 colorectal carcinoma

BACKGROUND/AIMS: The purpose of this study was to evaluate the risk of lymph node metastasis in patients with T1 colorectal carcinoma based on a uniform histopathology system, and to accomplish guidelines for additional surgery for endoscopically or locally removed T1 colorectal carcinoma. METHODOLOGY: A review was performed of 301 patients who underwent curative resection for T1 colorectal carcinoma between January 1970 and March 2001. The following clinicopathologic variables were evaluated using univariate and multivariate analysis: sex, age, location, size of tumor, macroscopic appearance, depth of submucosal invasion, lymphovascular invasion, and histologic grade. Lesions were subdivided according to the depth of submucosal invasion: sm1, submucosal invasion up to 500 microm from the muscularis mucosa; sm2, submucosal invasion between 500 and 1000 microm; sm3, submucosal invasion beyond 1000 microm. RESULTS: The overall lymph node metastasis rate was 6.3 per cent (19 of 301). Depth of submucosal invasion (sm3) and presence of lymphovascular invasion were significant risk factors for lymph node metastasis both univariately and multivariately. CONCLUSIONS: The findings of the current study demonstrated that significant risk factors for lymph node metastasis were level of submucosal invasion (sm3) and the presence of lymphovascular invasion. Surgery is indicated for patients with adverse factors.     

影响大肠癌淋巴结转移的因素间相关性探讨

目的研究影响大肠癌淋巴结转移的各种临床及病理因素之间的关系,为临床诊断及治疗提供参考.方法收集我院1975/1999年间手术治疗的大肠癌1374例,对全部病例及随访资料进行分析,建立ACCESS数据库,进行检索,采用排列组合的方法,逐个分析年龄、浸润深度、侵犯肠管周径、病理类型、分化程度、生长方式、肿瘤部位之间的相关性.统计方法采用行×列表资料的χ2检验.结果小于30岁年龄组大肠癌浸润肠管周径较其他年龄组高,其粘液腺癌、印戒细胞癌所占比例分别为22.7%(17/75),14.7%(11/75),较其他年龄组均多(P=0.000 χ2=72.22);与肿瘤浸润肠管周径有关的因素有肿瘤浸润肠壁深度(P=0.000 χ2=353.58),肿瘤生长方式(P=0.000χ2=155.35),肿瘤分化程度(P=0.035 χ2=13.53)肿瘤病理类型(P=0.000 χ2=31.64),肿瘤部位(P=0.000χ2=44.73);粘液腺癌及印戒细胞癌浸润至浆膜层的比例为81.6%(120/147)和86.36%(19/22)显著高于腺癌组67.7%(574/848);分化程度低的肿瘤及浸润性生长的肿瘤其浸润肠壁的深度增高;直肠癌及乙状结肠癌浸润到肠壁外的比例分别为要较其他组低(P=0.000 χ2=36.96).升结肠,横结肠,降结肠癌中粘液腺癌所占比例均较乙状结肠及直肠高(P=0.000χ2=83.55),其中横结肠癌中粘液腺癌所占比例高达38.5%(40/104).高分化,中分化,低分化癌中浸润性生长者分别为55.8%(191/342),62.5%(226/361),68.9%(59/86)组间比较有显著性差别(P=0.002 χ2=21.48).结论影响大肠癌淋巴结转移的各因素之间是相互联系、相互影响的.不可能以单一的某种因素作为判断其有无淋巴结转移的指标,临床上需综合分析各种因素所起的作用才能对病情进行合理正确的评估,制定合理的治疗方案.     

Distribution of lymph node metastasis in gastric carcinoma

BACKGROUND/AIMS: In gastric cancer, appropriate lymph node dissection increases survival, and hence it is of value to determine lymph node metastasis distribution in the early phase of progression. METHODOLOGY: This study involved a series of 274 consecutive patients with 1-6 lymph node metastases occurring after resection. The pattern of lymph node metastases was analyzed retrospectively. RESULTS: Of 102 patients with single lymph node metastasis, over 60% of metastases occurred in specific lymph nodes for each tumor. However, the remainder was scattered in an unpredictable manner including the para-aortic lymph nodes. Despite variations in invasiveness of tumors in patients with a single lymph node, the distribution remained unchanged. Nor was there any change in patients with an increased number of metastatic lymph nodes. However, in the latter group a higher proportion of metastases were widespread. About 85-90% of node was located within paragastric lymph nodes. CONCLUSIONS: Over 60% of metastatic lymph nodes would be eliminated by the dissection of specific areas determined by the site of the tumor. If the concept of sentinel lymph nodes in gastric cancer is valid, navigation surgery will be necessary for patients with early gastric cancer to locate such unpredictable metastasis.     

Identification of risk factors for lymph node metastasis of colorectal cancer

BACKGROUND/AIMS: Although lymph node metastasis is widely considered to be the potent prognostic factor in colorectal cancer patients, the clinical risk factors for lymph node metastasis in these patients have been scarcely analyzed. METHODOLOGY: The clinical records of 2125 patients who underwent colonoscopy and were diagnosed with colorectal cancer were reviewed. RESULTS: Multivariate analysis revealed that an increase in T stage (odds ratio (OR); 2.54, 95% confidence interval (CI) 2.17-2.98), and tumors with high grade pathology (OR; 1.63, 95% CI 1.10-2.41) were identified as the independent predictive factors for the presence of lymph node metastasis. On the other hand, the presence of synchronous adenomas (OR; 0.78, 95% CI 0.65-0.95) was a predictor for being free of lymph node metastasis. Stratification of the risk according to age and gender revealed that a tumor located in the right colon indicated significant risk for patients less than 50 years old (OR; 2.23, 95% CI 1.01-4.95), whereas tumors with high grade pathology indicated a significant risk only in female patients (OR; 1.74, 95% CI 1.01-3.00). CONCLUSIONS: The significant risk factors for lymph node metastasis were elucidated, and may facilitate surgeons in deciding the best surgical procedure to implement and pathologists in treating resected specimens.     

Predictive factors for lymph node metastasis in t1 stage colorectal Carcinomas

Purpose Selective endoscopie resection may cure early colorectal cancer (Tl), but the management is controversial. There is concern about the small risk of lymph node metastasis, which will not be treated by endoscopie resection alone. The authors sought predictive markers of lymph node metastasis to assist patient management. METHODS: The authors retrospectively analyzed consecutive cases of Tl stage colorectal cancer resected using endoscopie resection or bowel surgery over the period 1979 to 2000. The risk of lymph node metastasis was analyzed using logistic regression model for the markers selected by univariate analysis: the type of initial treatment, depth of submucosal invasion, lymphatic channel invasion, differentiation of histology, and invasive front histology. RESULTS: Two hundred seventy-eight patients were available for study. Twenty-one had lymph node metastasis. Depth of submucosal invasion (2 2,000 yum) and lymphatic channel invasion significantly predicted risk of lymph node metastasis in multivariate analysis. When these two factors were adopted for the prediction of lymph node metastasis, sensitivity, specificity, positive predictive value, and negative predictive value were 100, 55.6, 15.6, and 100 percent, respectively. CONCLUSIONS: Depth of submucosal invasion and lymphatic channel invasion were accurate predictive factors for lymph node metastasis. These two factors could be used in selecting appropriate cases for surgery after endoscopie resection. Poster presentation at meeting of the American Society of Colon and Rectal Surgeons, San Diego, California, June 2 to 7, 2001.     

Radiation therapy for abdominal lymph node metastasis from hepatocellular carcinoma

Background We report the results of radiotherapy for abdominal lymph node metastasis from hepatocellular carcinoma (HCC). Methods From 1998 to 2004, 45 cases were treated with radiotherapy (RT), with a dose between 30 and 55 Gy. The radiation response, overall survival, prognostic factors, and complications were evaluated. Results Thirty-nine cases were able to be evaluated for response: 10 cases showed complete response; 21 cases showed a partial response; and 8 cases showed stable disease. The overall response rate was 79.5%. The response rate was 87.5% for patients receiving ≥40 Gy₁₀ (biologically effective dose, α/β = 10) and 42.9% for patients receiving <40 Gy₁₀ (P = 0.02). The median survival time was 10 months for responders and 6 months for nonresponders (P = 0.01). The absence of other concurrent distant metastasis and controllable primary HCC were significant prognostic factors. RT induced gastric or duodenal ulcer development in nine patients. All of these patients had received more than 50 Gy₁₀, and these complications were not detected among patients receiving <50 Gy₁₀ (0% vs 37.5%, P < 0.01). Conclusions RT was an effective treatment modality, and the absence of concurrent distant metastasis and controllable primary tumor were significant prognostic factors. However, considering the high rate of RT-induced morbidity, 40 Gy₁₀ to 50 Gy₁₀ might be the optimal RT dose.     

Endoscopic treatment of submucosal invasive colorectal carcinoma with special reference to risk factors for lymph node metastasis

A clinicopathological analysis of the risk factors for lymph node metastasis was performed in 177 patients with submucosal invasive colorectal carcinoma (CRC). The submucosal deepest invasive portion was histologically subclassified as well (W), moderately (M), or poorly (Por) differentiated. M type was further subdivided into moderately-well (Mw) and moderatelypoorly (Mp) differentiated. The pattern of tumor growth was classified as polypoid growth (PG) and non-polypoid growth (NPG). Lymph node metastasis was detected in 21 (12%) of the 177 patients. Macroscopically, type IIc and IIa+IIc lesions showed a significantly higher incidence of lymph node metastasis (44% and 30%) than type IIa and I (4% and 8%). Regarding the histologic subclassification, Por and Mp lesions showed a significantly higher incidence of lymph node metastasis (67% and 37%) than W and Mw lesions (4% and 14%). NPG tumors showed a significantly higher incidence of lymph node metastasis (29%) than PG tumors (7%). The depth of submucosal invastion and lymphatic invasion (ly) were also significantly correlated with incidence of lymph node metastasis (submucosal scanty (sm-s) invasion 4%, massive invasion 20%; ly(+) 23%, ly(?) 5%). None of the lesions with both sm-s invasion and of W or Mw type showed lymph node metastasis. These results indicate that submucosal invasive CRC with both sm-s invasion and of W or Mw type, which shows no ly, is the appropriate indication for endoscopic curative treatment.     

Clinical significance of lymph node metastasis in gastric cancer

Gastric cancer,one of the most common malignancies in the world,frequently reveals lymph node,peritoneum,and liver metastases.Most of gastric cancer patients present with lymph node metastasis when they were initially diagnosed or underwent surgical resection,which results in poor prognosis.Both the depth of tumor invasion and lymph node involvement are considered as the most important prognostic predictors of gastric cancer.Although extended lymphadenectomy was not considered a survival benefit procedure and was reported to be associated with high mortality and morbidity in two randomized controlled European trials,it showed significant superiority in terms of lower locoregional recurrence and disease related deaths compared to limited lymphadenectomy in a 15-year followup study.Almost all clinical investigators have reached a consensus that the predictive efficiency of the number of metastatic lymph nodes is far better than the extent of lymph node metastasis for the prognosis of gastric cancer worldwide,but other nodal metastatic classifications of gastric cancer have been proposed as alternatives to the number of metastatic lymph nodes for improving the predictive efficiency for patient prognosis.It is still controversial over whether the ratio between metastatic and examined lymph nodes is superior to the number of metastatic lymph nodes in prognostic evaluation of gastric cancer.Besides,the negative lymph node count has been increasingly recognized to be an important factor significantly associated with prognosis of gastric cancer.