Ki-67在直肠类癌中的表达及其意义

背景:直肠类癌属于神经内分泌肿瘤,临床上较少见。目前对直径1~2 cm的直肠类癌的治疗方式尚存在争议。目的:检测Ki-67在直肠类癌中的表达水平,探讨直肠类癌内镜切除治疗的疗效和安全性。方法:回顾性收集重庆三峡中心医院和武汉同济医院2008年1月至2013年12月期间确诊为直肠类癌,肿瘤直径1.5 cm、行内镜黏膜切除术的患者83例,分析其病例资料,并以免疫组化方法检测肿瘤组织Ki-67表达。结果:术前内镜超声检查显示83例患者肿瘤均位于黏膜层或黏膜下层,无固有肌层浸润或转移,术后平均随访38个月,无一例患者复发或转移。所有患者肿瘤组织Ki-67均呈低表达(0.84%±0.67%),肿瘤直径1.0 cm与1.0~1.5 cm组间性别、年龄、肿瘤部位、Ki-67表达水平差异无统计学意义(P0.05)。以Ki-67指数均值0.84%为临界值分组,两组间各项临床病理参数差异亦无统计学意义(P0.05)。结论:本组直径1.5 cm的直肠类癌Ki-67均呈低表达,提示肿瘤细胞增殖不活跃。对于直径1.5 cm、无固有肌层浸润或转移、Ki-67低表达的直肠类癌,内镜局部切除治疗安全、有效。     

胃肠道类癌内镜下诊治与预后分析

目的探讨胃肠道类癌内镜下诊治与预后。方法选取本院2000年3月-2007年3月诊治的37例胃肠道类癌患者,对其内镜表现、治疗情况及预后情况进行分析总结。结果肿瘤直径3～82 mm,平均直径(20±16.3)mm,其中浸润至黏膜下层者12例,至肌层者15例,至浆膜层者10例;伴有淋巴结转移5例。镜下表现:颜色与正常黏膜颜色相似者13例、黏膜表面为黄白色22例、红色2例。病灶黏膜光滑32例、黏膜呈糜烂3例、黏膜溃疡2例。质地较韧或中等者占多数,为32例;质地较脆且易出血者有5例。5例出现淋巴结转移患者中,以肿瘤直径不同分为大于20 mm组与小于20 mm组。小于20 mm组淋巴结转移1例,平均生存时间(86.3±37.6)个月;大于20 mm组淋巴结转移4例,平均生存时间(61.2±22.8)个月,两者比较有显著的统计学差异(P<0.001)。以浸润程度不同分为不超过肌层组与超过肌层组,结果发现浸润程度不超过肌层组平均生存时间(81.5±29.0)个月,浸润程度超过肌层组平均生存时间(50.7±10.4)个月,两组比较有显著的统计学差异(P=0.002)。结论消化道类癌虽然一般预后较为良好,但是一种潜在的恶性肿瘤,有着恶性肿瘤的一些组织浸润、淋巴结转移等特征。镜下单纯从形态学上难以区分类癌的良恶性。其预后主要取决于类癌的大小及浸润的深度。     

HER-2与Ki-67检测对直肠癌恶性程度和预后判定的价值

目的探讨HER-2与Ki-67检测在判定直肠癌恶性程度和预后的临床应用价值。方法选取已经确诊的127例直肠癌患者的病理切除组织及40例癌旁组织为研究对象,采用免疫组化的方法检测HER-2与Ki-67在直肠癌组织中及癌旁组织中的表达情况,并分析HER-2、Ki-67阳性表达情况与直肠癌病理特征的关系以及两者的相关性。结果HER-2与Ki-67在直肠癌中的表达阳性率均高于癌旁组织,差异有统计学意义(P0.05)。HER-2在不同肿瘤分化程度、年龄、浸润深度、淋巴结转移中呈现统计学意义(P0.05);在不同性别、年龄、肿瘤大小、肿瘤分期中无统计学意义(P0.05)。Ki-67的表达在不同肿瘤的分化程度、浸润深度、淋巴结转移、肿瘤大小中呈现统计学意义(P0.05);HER-2、Ki-67阳性患者的无病进展期和总生存期均短于影响的患者,差异有统计学意义(P0.05)。在不同性别、年龄中无统计学意义(P0.05)。经相关性分析发现,HER-2与Ki-67在直肠癌中的表达无关联(P0.05)。结论 HER-2与Ki-67与直肠癌的发展有密切关系,两组高表达往往预示着恶性程度高,预后差,联合检测对估算预后有重要价值。     

不同类型胃肠类癌的临床分析与比较

目的　分析不同病理类型胃肠类癌的临床特点 ,以提高对该类疾病的认识与诊治水平。方法　回顾性分析北京协和医院 1982～ 2 0 0 3年的病理分类胃肠类癌 36例 ,并根据世界卫生组织肿瘤国际组织学新分类标准 (2 0 0 0 )分为恶性类癌、类癌 2组 ;比较 2组类癌的发病年龄特点、临床表现差异、转移情况、在消化系统内分泌肿瘤和肿瘤中的发病比例以及确诊的主要手段等。结果 (1)患病比 :胃肠类癌占同期消化系统肿瘤的 0 .35 % ,占同期消化系统内分泌肿瘤的 10 .2 0 %。 (2 )年龄 :恶性类癌发病年龄为 (5 5 .8± 12 .8)岁 ,类癌发病年龄为 (45 .1± 12 .0 )岁 ,前者明显高于后者。 (3)部位 :类癌多发于直肠 (6 3% ) ,而发生于胃 (35 % )与结肠 (2 5 % )应考虑恶性类癌。(4)转移 :淋巴结与肝脏是恶性类癌常见的转移部位 (6 0 % ) ;胃与结肠部位的恶性类癌转移率明显高于直肠与其他部位。(5 )检查手段 :胃肠类癌的发现多依赖内镜检查 ,但直肠指检不应偏废。 (6 )类癌综合征的发生率低 ,恶性类癌多见。结论　胃肠类癌在消化系统肿瘤中的发病率较低 ,但并非罕见 ;直肠是类癌的好发部位 ,胃与结肠是恶性类癌的好发部位 ;恶性类癌发病年龄较大且易伴肝与淋巴结转移 ,类癌综合征多见于恶性类癌。     

直肠类癌16例临床及病理分析

目的探讨直肠类癌的临床及病例特点。方法收集我院1992年5月～2004年12月间经病理诊断证实的16例直肠类癌患者的临床资料,并进行回顾性分析。结果16例患者中,13例(81%)直肠类癌位于距肛门口8cm以内的直肠,经结肠镜检查确诊12例(75%)。免疫组化染色显示肿瘤可同时对多种神经内分泌标记物(神经特异性烯醇化酶、嗜铬粒蛋白、囊泡突触素等)显示阳性。结论直肠指检对发现直肠类癌有重要作用,影响直肠类癌预后的主要因素为肿瘤的大小、肿瘤的浸润及转移情况。对直肠类癌的治疗应持积极态度。     

Ki-67抗原表达与食管鳞癌临床病理特征及其预后的关系

为探讨食管鳞癌患者癌组织中增殖细胞核相关抗原Ki-67表达的临床意义，采用免疫组织化学S－P法检测了62例食管鳞癌患者癌组织标本中Ki-67的表达水平。结果证实，Ki-67表达与性别，年龄，淋巴结转移，远处转移无相关性（P＞0．05）。与肿瘤长径，食管壁浸润程度、pTMN分期及肿瘤分化程度呈正相关关系（P＜0．01）。高表达组患者术后3年生存率低于低表达组，但无统计学差异。认为Ki-67抗原表达与反映食管鳞癌恶性程度的临床病理参数呈正相关关系，但对预后无评价意义。     

RUNX3蛋白在人结直肠癌中的表达及其临床意义

背景:Runx3(runt相关转录因子3)基因是一种新发现的抑癌基因,近年研究发现Runx3异常表达与人类多种消化系肿瘤的发生密切相关。目的:研究人结直肠癌中RUNX3蛋白的表达,分析其表达与结直肠癌临床病理特征的关系。方法:以免疫组化方法检测90例结直肠癌患者的癌组织和癌旁组织中RUNX3蛋白的表达。结果:结直肠癌组织中RUNX3蛋白的阳性表达率(47.8%,43/90)显著低于癌旁结直肠黏膜组织(100%,P<0.05)。RUNX3蛋白的表达与结直肠癌患者的性别、年龄、肿瘤部位、大小和组织学类型无关(P>0.05),与肿瘤浸润深度、分化程度、Dukes分期和有无淋巴结转移有关(P<0.05),浸润越深、分化程度越低、Dukes分期越晚和有淋巴结转移的癌组织,RUNX3蛋白低表达越明显。结论:RUNX3蛋白的表达可能与结直肠癌的浸润、分化和转移相关,提示RUNX3蛋白表达下调可能对结直肠癌的发生、发展具有重要作用。     

结直肠癌组织中PAQR3、PDCD4基因甲基化水平与结直肠癌的关系

目的研究结直肠癌组织抑癌基因PAQR3、PDCD4甲基化水平,以及二者与结直肠癌临床资料之间的关系。方法收集2013~2014年结直肠癌及癌旁正常组织标本各54例,用甲基化特异性PCR(MSP)法检测结直肠标本中PAQR3、PDCD4基因甲基化水平。结果 (1)PAQR3癌组织和癌旁组织甲基化率分别为33.3%(18/54)和5.6%(3/54),差异显著(P0.05);PDCD4癌组织和癌旁组织发生甲基化率为分别为53.7%(29/54)和7.4%(7/54),差异显著(P0.001)。二者同时检测的甲基化阳性率为87%,PAQR3和PDCD4没有相关性(R=0.155,P=0.408)。(2)结直肠癌组织中PAQR3基因甲基化与性别、肿瘤部位无关,年龄越大、分化程度越低、淋巴结转移、浸润越深者,PAQR3甲基化发生率越高。结直肠癌组织中PDCD4基因甲基化与性别、年龄、肿瘤部位无关,分化程度越低、淋巴结转移、浸润越深者,PDCD4甲基化发生率越高。结论结直肠癌中PAQR3、PDCD4发生了甲基化,PAQR3基因甲基化水平与年龄、分化程度、有无淋巴结转移、肿瘤浸润深度有关,PDCD4甲基化水平与分化程度、有无淋巴结转移、肿瘤浸润深度有关。     

伴淋巴结转移的早期胃癌病理组织形态学研究

目的通过研究早期胃癌发展过程中组织形态学的变迁，预测其淋巴结转移的难易程度。方法以伴淋巴结转移的81例早期胃癌作为转移组，抽取81例不伴淋巴结转移者作为对照组，两组均含11例黏膜内癌，70例黏膜下癌，组织学分类及肿瘤部位相似，具可比性。将各组的肿瘤灶亚分类为表层部、浸润部，各病灶的病理组织形态学依据规范分为分化型、混合型、未分化型。对各病例相关因子进行统计学分析研究。结果浸润部较表层部组织分化程度低下者，转移组为40．7％，较对照组的11．9％为高。转移组表层部的分化型胃癌和未分化型胃癌，其浸润部同一组织学分化程度较对照组为低，其差异有统计学意义（分别为P〈0．01和P〈0．05）。转移组的表层部与浸润部的分化程度合致率为61．7％，明显低于对照组的77．8％，其差异有统计学意义（P〈0．05）。转移组的男女比率为1．9：1，较对照组的3．3：1为低，其差异有统计学意义（P〈0．05）。结论早期胃癌中，癌灶水平方向和浸润先端部的垂直方向组织学分化程度的变化更易出现。浸润部与黏膜同有层癌组织学分化程度不同者，尤其是组织学分化程度趋低下者易出现淋巴结转移。女性较男性更易出现淋巴结转移。     

Tumor size is irrelevant in predicting malignant potential of carcinoid tumors of the rectum

The malignant potential and prognosis of rectal carcinoids are said to be related to tumor size. Our study assessed if size could predict the malignant potential and hence its management. All patients in the Department of Colorectal Surgery, Singapore General Hospital, who underwent surgery for rectal carcinoid tumors between February 1991 and September 2000 were analyzed. Twenty patients (11 men), median age 48 years (range, 33–77 years) were studied. Median follow-up was 40 months (range, 5–120 months). The median tumor diameter was 2.5 cm (range, 0.1–5.0 cm). Eleven patients underwent radical resection and 9 patients had local resection for a presumed benign tumor. Morbidity was 15% and postoperative death was 5%. Overall median survival was 24 months (range, 5–120 months). One patient had an anterior resection for rectal adenocarcinoma but had an incidental 0.1-cm carcinoid tumor near the resection margin which on histology was found to have carcinoid tumor metastasis to 2 out of 12 lymph nodes. In conclusion, tumor size cannot predict malignant potential as even small tumors (<1 cm) can be malignant. Accurate preoperative staging with radical surgery may be required. Received: 20 September 2000 / Accepted in revised form: 6 April 2001     

18F-fluorodeoxyglucose positron emission tomography as a diagnostic tool for malignancy of adrenocortical tumours? Preliminary results in 13 consecutive patients

DESIGN: This study is a preliminary report on 18F-fluorodeoxyglucose (18F-FDG) uptake for the characterization of hypersecretory or non-hypersecretory adrenocortical masses in patients without known neoplastic disease, thereby minimizing the presence of adrenal metastases, and without phaeochromocytoma, in comparison with computed tomography (CT) scanning and with iodocholesterol scintigraphy. METHODS: Thirteen consecutive patients with an adrenal mass scheduled to have surgery, underwent hormonal exploration, a CT scan for tumour size measurement and an 18F-FDG positron emission tomography scan. Eleven of these patients also had unenhanced density measurement at CT scan and iodocholesterol scintigraphy. RESULTS: CT-scanned adrenal masses ranged in size from 2.2 to 10 cm; attenuation value was <10 Hounsfield units (HUs) in two cases and >10 HU in nine. All benign lesions demonstrated iodocholesterol uptake. In the case of malignant tumours, results were non-homogeneous: no uptake, uptake and non-informative scintigraphy. All patients with an adrenocortical carcinoma had positive adrenal 18F-FDG uptake (n=3), one had a liver metastasis with positive 18F-FDG uptake, one showed 18F-FDG uptake in an adrenal metastasis from an unknown primary kidney tumour. All patients with a benign adrenocortical lesion had negative 18F-FDG uptake (n=9). Patients' lesions were hypersecretory (n=5), or non-hypersecretory (n=8), regardless of the pathology. CONCLUSION: This short preliminary study indicates that 18F-FDG gave a correct classification of tissue characterization with accurate identification of malignant lesions, as well as the disease stage (metastasis or primary). These promising preliminary results on adrenocortical lesions, seldom studied with 18F-FDG, are to be confirmed in larger series.     

Values and limitations of 18F-fluorodeoxyglucose-positron-emission tomography with preoperative evaluation of patients with pancreatic masses

The aim of this study was to determine the value and limitations of 18F-fluorodeoxyglucose (FDG)-position-emission tomography (PET) for differentiating benign and malignant pancreatic disease and for staging malignant disease. One hundred fifty-nine patients with 89 malignant and 70 benign pancreatic lesions all received PET, computed tomography (CT), and endoscopic retrograde cholangiopancreatography (ERCP) before pancreatic surgery. The original reports were compared for all patients (group I; N = 159), for a subgroup that neither had fasting plasma glucose levels > or =130 mg/dL or known elevated levels of C-reactive protein ([CRP], group II; n = 123), and for the remaining patients (group III; n = 36). For group I, accuracy values (areas under receiver operating characteristic [ROC] curves) for differentiation of benign/malignant masses were 0.86 (PET), 0.93 (ERCP), 0.82 (CT), and 0.95 for ERCP + PET (N = 159). For group II, ROC areas increased to 0.92 (PET), 0.94 (p < 0.05; n = 123) (ERCP), 0.82 (CT), 0.97 (p < 0.05; n = 123) (ERCP + PET). The results for group III were 0.71 (PET), 0.81 (CT), and 0.93 (ERCP); (n = 36). With 54 patients of group II that either had contradictory or indeterminate/technically unsuccessful CT/ERCP, PET was correct in 43 patients (84%). Sensitivity/specificity for lymph node staging was 49%/63%, respectively. For patients with hepatic metastasis, PET was 70% sensitive and 95% specific, missing some metastasis that were <1 cm. PET detected peritoneal metastasis in 25% of patients, missing poorly localized microscopic spread. For selected patients who have indeterminate pancreatic masses but no hyperglycemia or serologic evidence of active inflammation, FDG-PET is an independent functional assay that significantly adds to the diagnostic accuracy of ERCP and CT in the differentiation of benign and malignant pancreatic disease. PET can reliably detect hepatic, peritoneal, and other distant metastases that are > or =1 cm.     

DNA ploidy pattern in rectal carcinoid tumors

The nuclear DNA pattern of 22 rectal carcinoids was determined by cytophotometry of paraffin embedded tissues. The results were compared with clinical as well as histopathologic features of the tumor. Three of the carcinoids with synchronous or metachronous metastasis had aneuploid DNA pattern, whereas 19 tumors with no metastasis showed diploid DNA pattern. No other single clinical or pathologic feature of the tumor could predict more accurately the malignant potential and the subsequent course of the rectal carcinoid. It is concluded that DNA aneuploidy in rectal carcinoid tumors is not so rare as indicated by earlier studies and that it is a factor of significant prognostic value.Dr. George Tsioulias is a recipient of the Monbusho Scholarship (Japanese Ministry of Education).     

Prognosis of low-risk papillary thyroid carcinoma patients: its relationship with the size of primary tumors

It is well-known that papillary thyroid carcinoma (PTC) has a generally indolent character and shows a favorable prognosis unless it has no high-risk features such as clinical lymph node metastasis, distant metastasis, and significant extrathyroid extension. In this study, we investigated the prognosis of 3,965 patients with PTC without these features. We classified these patients into 3 groups: T-1, tumor ≤ 2 cm (n = 2,591); T-2, tumor 2.1-4 cm (n = 1,123); T-3, tumor > 4 cm (n = 251). Ten-year recurrence rates of T-1, T-2, and T-3 patients were 0.3, 1.3, and 1.9% for the thyroid (in the subset of patients who underwent limited thyroidectomy), 1.9, 4.6, and 8.1% for lymph nodes, and 0.4, 1.6, and 3.4% for distant organs, respectively. A tumor size larger than 2 cm had an independent prognostic impact on all these recurrences also on multivariate analysis. These findings suggest that PTC larger than 2 cm exhibited more aggressive biological characteristics than that measuring 2 cm or less, even though it had no other high-risk features. However, the incidences of distant recurrence and carcinoma death were still low and it remains unclear whether extensive surgery is mandatory for otherwise low-risk PTC patients with large tumor.     

Endosonographic features predictive of benign and malignant gastrointestinal stromal cell tumours

BACKGROUND/AIM: Some endoscopic ultrasonographic (EUS) features have been reported to be suggestive of malignancy in gastrointestinal stromal cell tumours (SCTs). The aim of this study was to assess the predictive value of these features for malignancy. METHODS: A total of 56 histologically proven cases of SCT studied by EUS between 1989 and 1996 were reviewed. There were 42 gastric tumours, 12 oesophageal tumours, and two rectal tumours. The tumours were divided into two groups: (a) benign SCT, comprising benign leiomyoma (n = 34); (b) malignant or borderline SCT (n = 22), comprising leiomyosarcoma (n = 9), leiomyoblastoma (n = 9), and leiomyoma of uncertain malignant potential (n = 4). The main EUS features recorded were tumour size, ulceration, echo pattern, cystic spaces, extraluminal margins, and lymph nodes with a malignant pattern. The two groups were compared by univariate and multivariate analysis. RESULTS: Irregular extraluminal margins, cystic spaces, and lymph nodes with a malignant pattern were most predictive of malignant or borderline SCT. Pairwise combinations of the three features had a specificity and positive predictive value of 100% for malignant or borderline SCT, but a sensitivity of only 23%. The presence of at least one of these three criteria had 91% sensitivity, 88% specificity, and 83% predictive positive value. In multivariate analysis, cystic spaces and irregular margins were the only two features independently predictive of malignant potential. The features most predictive of benign SCTs were regular margins, tumour size < or = 30 mm, and a homogeneous echo pattern. When the three features were combined, histology confirmed a benign SCT in all cases. CONCLUSIONS: The combined presence of two out of three EUS features (irregular extraluminal margins, cystic spaces, and lymph nodes with a malignant pattern) had a positive predictive value of 100% for malignant or borderline gastrointestinal SCT. Tumours less than 30 mm in diameter with regular margins and a homogeneous echo pattern are usually benign.     

Carcinoid tumor of the rectum

PURPOSE: This study was designed to evaluate the clinical characteristics, surgical treatment, and outcome of carcinoid tumors of the rectum and to assess flow cytometry deoxyribonucleic acid (DNA) analysis as a potential prognostic factor for management of these tumors. METHODS: Medical records, tumor registry database, and pathology slides were retrospectively reviewed. Flow cytometry DNA analysis was performed on archived specimens. RESULTS: One hundred nine patients with rectal carcinoid tumors underwent surgery between 1962 and 1987. Follow-up was available in 86 patients for a mean period of 12 years. Of 100 patients with tumors less than 2 cm, only one with a 1.5 cm ulcerated tumor developed liver metastases. Of nine patients with a tumor more than or equal to 2 cm, three with known liver metastases underwent rectal biopsy only, and three had rectal biopsy and laparotomy with biopsy of liver metastases. Three patients underwent radical resection. Following abdominoperineal resection, one patient died with local recurrence after 5 years, and one developed hepatic recurrence after 5.5 years and died at 9 years. One patient with coloanal anastomosis developed local and hepatic metastases seven years after surgery and died at ten years. No patients developed carcinoid syndrome. DNA ploidy did not correlate with metastases at presentation or recurrence of carcinoid tumor. CONCLUSION: Radical resection of rectal carcinoids with ulceration or size greater than or equal to 2 cm is associated with a poor prognosis; however, survival may be long term, even in the presence of metastatic disease. DNA ploidy does not appear to be a useful prognostic factor for rectal carcinoid tumors.Poster presentation at the meeting of The American Society of Colon and Rectal Surgeons, Orlando, Florida, May 8 to 13, 1994.     

Rectal carcinoids: The most frequent carcinoid tumor

One hundred seventy patients with gastrointestinal carcinoid tumors were treated at Ochsner Clinic from 1958 to 1990. Ninety-four rectal carcinoid tumors were diagnosed and treated during this time. Carcinoid tumors of the rectum represented the most frequent primary site (55 percent), followed by carcinoids of the ileum (12 percent), appendix (12 percent), colon (6 percent), stomach (6 percent), jejunum (2 percent), pancreas (2 percent), and other (5 percent). One-half of rectal carcinoids were discovered during anorectal examination of asymptomatic patients. The remainder were found primarily by examination of patients for symptoms of benign anorectal conditions. The diagnosis of rectal carcinoid was made at the time of initial examination in 61 patients. This allowed definitive treatment in a single session by local excision and fulguration in 48 patients. The remainder were treated by repeat biopsy and fulguration (25 patients) or by transanal excision (12 patients). Overall, 85 carcinoid tumors of the rectum measuring <2 cm were treated by local excision and fulguration or by transanal excision, with an average five-year follow-up. There were no local recurrences. Ten patients with metastasizing rectal carcinoids averaging 4 cm were treated. All were symptomatic at presentation and fared poorly despite radical surgery. Three were alive at three years but only one survived five years. At our institution, rectal carcinoids were the most frequently detected carcinoid tumor. Small carcinoids of the rectum were adequately treated by local excision and fulguration or by transanal excision, with no local recurrence. The true incidence of rectal carcinoids is detected only with careful and complete rectal examination of the asymptomatic screening population by experienced surgeons. With more widespread screening of the well population, rectal carcinoids may become recognized as the most frequent human carcinoid tumor.Read at the XIIIth Biennial Congress of the International Society of University Colon and Rectal Surgeons, Graz, Austria, June 24 to 28, 1990.     

Prognostic value of lateral lymph node metastasis for advanced low rectal cancer

AIM： To evaluate the risk factors for lateral lymph node metastasis in patients with advanced low rectal cancer, in order to make the effective selection of patients who could benefit from lateral lymph node dissection, as well as the relationship of lateral lymph node metastasis with local recurrence and survival of patients with advanced low rectal cancer. METHODS： A total of 96 consecutive patients who underwent curative surgery with lateral pelvic lymphadenectomy for advanced lower rectal cancer were retrospectively analyzed. The relation of lateral lymph node metastasis with clinicopathologic characteristics, local recurrence and survival of patients was identified. RESULTS： Lateral lymph node metastasis was observed in 14.6% （14/96） of patients with advanced low rectal cancer. Lateral lymph node metastasis was detected in 10 （25.0%） of 40 patients with tumor diameter ≥ 5 cm and in 4 （7.1%） of 56 patients with tumor diameter 〈 5 cm. The difference between the significant （X^2 = 5.973, P = two groups was statistically 0.015）. Lateral lymph node metastasis was more frequent in patients with 4/4 diameter of tumor infiltration （7 of 10 cases, 70.0%）, compared with patients with 3/4, 2/4 and 1/4 diameter of tumor infiltration （3 of 25 cases, 12.0%; 3 of 45 cases, 6.7%; 1 of 16 cases, 6.3%） （X^2 = 27.944, P = 0.0001）. The lateral lymph node metastasis rate was 30.0% （9 of 30 cases）, 9.1% （4 of 44 cases） and 4.5% （1 of 22cases） for poorly, moderately and well-differentiated carcinoma, respectively. The difference between the three groups was statistically significant （X^2 = 8.569, P = 0.014）. Local recurrence was 18.8% （18 of 96 cases）, 64.3% （9 of 14 cases）, and 11.0% （9 of 82 cases） in patients with advanced low rectal cancer, in those with and without lateral lymph node metastasis, respectively. The difference between the two groups was statistically significant （X^2 = 22.308, P = 0.0001）. Kaplan-Meier survival analysis showed significant impr