| Theme | Metastasis in colorectal submucosal cancer of IIc origin | |
|---|---|---|
| Title | Clinicopathological study of risk factors associated with lymphnodal and hepatic metastasis of submucosal invasive colorectal carcinoma originating from IIc with special reference to PG and NPG classification | |
| Publish Date | 2006/03 | |
| Author | Masahiro Ikegami | Department of Pathology, The Jikei University School of Medicine |
| Author | Tiecheng Liu | Department of Pathology, The Jikei University School of Medicine |
| Author | Hirohiko Kobayashi | Department of Pathology, The Jikei University School of Medicine |
| Author | Hironori Ishii | Department of Pathology, The Jikei University School of Medicine |
| [ Summary ] | One hundred fifty nine surgically resected cases of colorectal carcinoma, associated with submucosal invasion, were reviewed in order to identify risk factors associated with lymphnodal and hepatic metastases. All tumors were classified as those either with or without lymphnodal or hepatic metastasis or having both. Metastatic involvement was seen in 12 cases (7.5 %). Seven factors were compared between the two groups : (1) the mode of intramucosal growth (polypoid or nonpolypoid) ; (2) the degree of submucosal invasion (sm1, 2 and 3 by the depth of invasion) ; (3) histologic differentiation (well, moderately or poorly differentiated) ; (4) the presence or absence of bud like structures in submucosal invasion ; (5) the presence or absence of lymphatic permeations in the colorectal wall ; (6) the presence or absence of venous invasion ; (7) macroscopic features. With multivariate analysis of these seven factors, the only variable considered on the basis of a logistic model in stepwise variable selections was the presence of lymphatic permeation. In addition, histological differentiation and the degree of submucosal invasion were statistically significant risk factors. Consequently, the most significant risk factors for metastasis in sm carcinomas were marked lymphatic permeation, submucosal invasion deeper than sm1b, and poor histological differentiation. With the lymphnodal and hepatic metastatic submucosal invasive colorectal carcinomas, only 5 lesions (62.5 %) were considered to have originated from superficial carcinoma and/or NPG carcinoma. Submucosal invasive colorectal carcinomas originating from superficial carcinoma and/or NPG carcinoma, can be considered high risk lesions when estimating the probability of lymphnodal and hepatic metastasis. This is especially so even considering that those lesions occupy a lower percentage of early carcinomas of the large bowel. |
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