Predictive value of histology at the invasive margin in the prognosis of early invasive colorectal carcinoma |
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Authors: | Tadahiko Masaki Tetsuichiro Muto |
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Institution: | (1) Division of Surgical Oncology, Department of Surgery, The University of Tokyo, Tokyo, Japan, JP |
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Abstract: | 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 |
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Keywords: | : malignant colorectal polyp lymph node metastasis rick factor endoscopic polypectomy local excision |
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