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Lymphatic Vessel Density at the Site of Deepest Penetration as a Predictor of Lymph Node Metastasis in Submucosal Colorectal Cancer

  • Published:
Diseases of the Colon & Rectum

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.

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Authors and Affiliations

  1. Department of Medicine and Molecular Science, Hiroshima University Graduate School of Biomedical Science, Hiroshima, Japan

    Iwao Kaneko M.D., Masanori Ito M.D. & Kazuaki Chayama M.D.

  2. Department of Endoscopy, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan

    Shinji Tanaka M.D., Ph.D., Shiro Oka M.D. & Toru Kawamura M.D.

  3. Health Service Center, Hiroshima University, Hiroshima, Japan

    Toru Hiyama M.D. & Masaharu Yoshihara M.D.

  4. Department of Health Science, Prefectural University of Hiroshima, Faculty of Human Culture and Society, Hiroshima, Japan

    Fumio Shimamoto M.D.

Authors
  1. Iwao Kaneko M.D.
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  2. Shinji Tanaka M.D., Ph.D.
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  3. Shiro Oka M.D.
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  4. Toru Kawamura M.D.
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  5. Toru Hiyama M.D.
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  6. Masanori Ito M.D.
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  9. Kazuaki Chayama M.D.
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Correspondence to Shinji Tanaka M.D., Ph.D..

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Supported by a grant from the Japanese Society of Gastroenterological Endoscopy, Chugoku Branch.

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Kaneko, I., Tanaka, S., Oka, S. et al. Lymphatic Vessel Density at the Site of Deepest Penetration as a Predictor of Lymph Node Metastasis in Submucosal Colorectal Cancer. Dis Colon Rectum 50, 13–21 (2007). https://doi.org/10.1007/s10350-006-0745-5

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