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Predictive Histopathologic Factors for Lymph Node Metastasis in Patients With Nonpedunculated Submucosal Invasive Colorectal Carcinoma

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Diseases of the Colon & Rectum

PURPOSE

Risk factors for lymph node metastasis in patients with nonpedunculated submucosal invasive colorectal carcinoma remain to be characterized. This study examines the relationship between lymph node metastasis and clinicopathologic factors in nonpedunculated submucosal invasive colorectal carcinoma.

METHODS

The study cohort comprised 155 patients who had undergone surgical treatment for nonpedunculated submucosal invasive colorectal carcinoma. The clinicopathologic factors investigated included gender, age, tumor location, macroscopic type, tumor size, histologic type and grade, intramucosal growth pattern, lymphatic invasion, venous invasion, degree of focal dedifferentiation at the submucosal invasive front, status of the remaining muscularis mucosa, and the depth and width of submucosal invasion.

RESULTS

Lymph node metastases were found in 19 patients (12.3 percent). Univariate analysis showed that lymphatic invasion, focal dedifferentiation at the submucosal invasive front, status of the remaining muscularis mucosa, and depth of submucosal invasion all had a significant influence on lymph node metastasis. Multivariate analysis showed lymphatic invasion (P = 0.014) and high-grade focal dedifferentiation at the submucosal invasive front (P = 0.049) to be independent factors predicting lymph node metastasis. No lymph node metastasis was found in tumors with a depth of submucosal invasion of <1.3 mm.

CONCLUSIONS

Lymphatic invasion and high-grade focal dedifferentiation at the submucosal invasive front are important predictors of lymph node metastasis in patients with nonpedunculated submucosal invasive colorectal carcinoma. Depth of submucosal invasion can be used as an identifying marker for patients who do not require subsequent surgery after endoscopic resection.

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REFERENCES

  1. K Kitamura H Taniguchi T Yamaguchi K Sawai T Takahashi (1997) ArticleTitleClinical outcome of surgical treatment for invasive early colorectal cancer in Japan Hepatogastroenterology 44 108–15 Occurrence Handle9058127 Occurrence Handle1:STN:280:DyaK2s3htFWhuw%3D%3D

    PubMed  CAS  Google Scholar 

  2. BJ Rembacken T Fujii A Cairns et al. (2000) ArticleTitleFlat and depressed colonic neoplasms: a prospective study of 1000 colonoscopies in the UK Lancet 355 1211–4 Occurrence Handle10.1016/S0140-6736(00)02086-9 Occurrence Handle1:STN:280:DC%2BD3c3jtFSksw%3D%3D Occurrence Handle10770302

    Article  CAS  PubMed  Google Scholar 

  3. J Moreaux M Catala (1987) ArticleTitleCarcinoma of the colon: long-term survival and prognosis after surgical treatment in a series of 798 patients World J Surg 11 804–9 Occurrence Handle1:STN:280:DyaL1c7ivVyiuw%3D%3D Occurrence Handle3433796

    CAS  PubMed  Google Scholar 

  4. MJ Chantereau J Faivre MC Boutron et al. (1992) ArticleTitleEpidemiology, management, and prognosis of malignant large bowel polyps within a defined population Gut 33 259–63 Occurrence Handle1:STN:280:DyaK387nsFKjsA%3D%3D Occurrence Handle1541423

    CAS  PubMed  Google Scholar 

  5. KS Mainprize NJ Mortensen BF Warren (1998) ArticleTitleEarly colorectal cancer: recognition, classification and treatment Br J Surg 85 469–76 Occurrence Handle9607526 Occurrence Handle1:STN:280:DyaK1c3mvVGnsA%3D%3D

    PubMed  CAS  Google Scholar 

  6. T Akasu H Kondo Y Moriya et al. (2000) ArticleTitleEndorectal ultrasonography and treatment of early stage rectal cancer World J Surg 24 1061–8 Occurrence Handle10.1007/s002680010151 Occurrence Handle1:STN:280:DC%2BD3cvos12mtQ%3D%3D Occurrence Handle11036283

    Article  CAS  PubMed  Google Scholar 

  7. Sobin LH, Wittekind Ch., eds. UICC TNM classification of malignant tumours. 5th ed. New York: John Wiley & Sons, 1997.

  8. Japanese Society for Cancer of the Colon and Rectum. Japanese classification of colorectal carcinoma. First English edition. Tokyo: Kanehara & Co., 1997.

  9. CH Shatney PH Lober VA Gilbertsen H Sosin (1974) ArticleTitleThe treatment pedunculated adenomatous colorectal polyps with focal cancer Surg Gynecol Obstet 139 845–50 Occurrence Handle1:STN:280:DyaE2M%2FjsVelsQ%3D%3D Occurrence Handle4424895

    CAS  PubMed  Google Scholar 

  10. WI Wolff H Shinya (1975) ArticleTitleDefinitive treatment of “malignant” polyps of the colon Ann Surg 182 516–25 Occurrence Handle1:STN:280:DyaE28%2FjvVOgtA%3D%3D Occurrence Handle1180588

    CAS  PubMed  Google Scholar 

  11. BC Morson JE Whiteway EA Jones FA Macrae CB Williams (1984) ArticleTitleHistopathology and prognosis of malignant colorectal polyps treated by endoscopic polypectomy Gut 25 437–44 Occurrence Handle1:STN:280:DyaL2c7otlOlsg%3D%3D Occurrence Handle6714785

    CAS  PubMed  Google Scholar 

  12. RC Haggitt RE Glotzbach EE Soffer LD Wruble (1985) ArticleTitlePrognostic factors in colorectal carcinomas arising in adenomas: implications for lesions removed by endoscopic polypectomy Gastroenterology 89 328–36 Occurrence Handle4007423 Occurrence Handle1:STN:280:DyaL2M3jtFyrtA%3D%3D

    PubMed  CAS  Google Scholar 

  13. GM Wilcox PB Anderson TA Colacchio (1986) ArticleTitleEarly invasive carcinoma in colonic polyps: a review of the literature with emphasis on the assessment of the risk of metastasis Cancer 57 160–71 Occurrence Handle1:STN:280:DyaL28%2FnvFSmsQ%3D%3D Occurrence Handle3510072

    CAS  PubMed  Google Scholar 

  14. JP Cranley RE Petras WD Carey K Paradis MV Sivak (1986) ArticleTitleWhen is endoscopic polypectomy adequate therapy for colonic polyps containing invasive carcinoma? Gastroenterology 91 419–27 Occurrence Handle1:STN:280:DyaL283kvVGhsg%3D%3D Occurrence Handle3721127

    CAS  PubMed  Google Scholar 

  15. S Coverlizza M Risio A Ferrari CM Fenoglio-Preiser FP Rossini (1989) ArticleTitleColorectal adenomas containing invasive carcinoma: pathologic assessment of lymph node metastatic potential Cancer 64 1937–47 Occurrence Handle1:STN:280:DyaK3c%2Fgt1OqtQ%3D%3D Occurrence Handle2477139

    CAS  PubMed  Google Scholar 

  16. S Tanaka T Yokota D Saito S Okamoto Y Oguro S Yoshida (1995) ArticleTitleClinicopathologic features of early rectal carcinoma and indications for endoscopic treatment Dis Colon Rectum 38 959–63 Occurrence Handle1:STN:280:DyaK2MzosFGgtw%3D%3D Occurrence Handle7656744

    CAS  PubMed  Google Scholar 

  17. R Kikuchi M Takano K Takagi et al. (1995) ArticleTitleManagement of early invasive colorectal cancer: risk of recurrence and clinical guidelines Dis Colon Rectum 38 1286–95 Occurrence Handle1:STN:280:DyaK287gtFGmuw%3D%3D Occurrence Handle7497841

    CAS  PubMed  Google Scholar 

  18. HS Cooper LM Deppisch WK Gourley et al. (1995) ArticleTitleEndoscopically removed malignant colorectal polyps: clinicopathologic correlations Gastroenterology 108 1657–65 Occurrence Handle1:STN:280:DyaK2M3osF2kuw%3D%3D Occurrence Handle7768369

    CAS  PubMed  Google Scholar 

  19. EE Volk JR Goldblum RE Petras WD Carey VW Fazio (1995) ArticleTitleManagement and outcome of patients with invasive carcinoma arising in colorectal polyps Gastroenterology 109 1801–7 Occurrence Handle1:STN:280:DyaK28%2Fos1OrtQ%3D%3D Occurrence Handle7498644

    CAS  PubMed  Google Scholar 

  20. P Netzer C Forster R Biral et al. (1998) ArticleTitleRisk factor assessment of endoscopically removed malignant colorectal polyps Gut 43 669–74 Occurrence Handle1:STN:280:DyaK1M%2FntFamtw%3D%3D Occurrence Handle9824349 Occurrence Handle10.1136/gut.43.5.669

    Article  CAS  PubMed  Google Scholar 

  21. S Muller IM Chesner MJ Egan et al. (1989) ArticleTitleSignificance of venous and lymphatic invasion in malignant polyps of the colon and rectum Gut 30 1385–91 Occurrence Handle1:STN:280:DyaK3c%2FmtV2htQ%3D%3D Occurrence Handle2583564

    CAS  PubMed  Google Scholar 

  22. JH Bond (1993) ArticleTitlePolyp guideline: diagnosis, treatment, and surveillance for patients with nonfamilial colorectal polyps Ann Intern Med 119 836–43 Occurrence Handle1:STN:280:DyaK3szptlSjsQ%3D%3D Occurrence Handle8379605

    CAS  PubMed  Google Scholar 

  23. T Coutsoftides MV Sivak SuffixJr SP Benjamin D Jagelman (1978) ArticleTitleColonoscopy and the management of polyps containing invasive carcinoma Ann Surg 188 638–41 Occurrence Handle1:STN:280:DyaE1M%2FmtFWlsg%3D%3D Occurrence Handle718288

    CAS  PubMed  Google Scholar 

  24. S Nivatvongs A Rojanasakul HM Reiman et al. (1991) ArticleTitleThe risk of lymph node metastasis in colorectal polyps with invasive adenocarcinoma Dis Colon Rectum 34 323–8 Occurrence Handle1:STN:280:DyaK3M7ns1yisA%3D%3D Occurrence Handle1848810

    CAS  PubMed  Google Scholar 

  25. S Kyzer LR Bégin PH Gordon B Mitmaker (1992) ArticleTitleThe care of patients with colorectal polyps that contain invasive adenocarcinoma: endoscopic polypectomy or colectomy? Cancer 70 2044–50 Occurrence Handle1:STN:280:DyaK3s%2FgslOgtw%3D%3D Occurrence Handle1394034

    CAS  PubMed  Google Scholar 

  26. S Kudo (1993) ArticleTitleEndoscopic mucosal resection of flat and depressed types of early colorectal cancer Endoscopy 25 455–61 Occurrence Handle1:STN:280:DyaK2c%2FosFeitw%3D%3D Occurrence Handle8261988 Occurrence Handle10.1055/s-2007-1010367

    Article  CAS  PubMed  Google Scholar 

  27. T Shimoda M Ikegami J Fujisaki T Matsui S Aizawa E Ishikawa (1989) ArticleTitleEarly colorectal carcinoma with special reference to its development de novo Cancer 64 1138–46 Occurrence Handle1:STN:280:DyaL1Mzjs1Kntg%3D%3D Occurrence Handle2758387

    CAS  PubMed  Google Scholar 

  28. Y Kurisu T Shimoda A Ochiai Y Nakanishi I Hirata K Katsu (1999) ArticleTitleHistologic and immunohistochemical analysis of early submucosal invasive carcinoma of the colon and rectum Pathol Int 49 608–16 Occurrence Handle10.1046/j.1440-1827.1999.00928.x Occurrence Handle1:STN:280:DyaK1MvjsF2jtg%3D%3D Occurrence Handle10504521

    Article  CAS  PubMed  Google Scholar 

  29. Hamilton SR, Aaltonen LA., eds. World Health Organization classification of tumours: pathology and genetics of tumours of the digestive system. Lyon: IARC Press, 2000.

  30. S Maeo Y Ajioka H Watanabe M Kobayashi M Kobayashi (1995) ArticleTitleThe proliferating cell nuclear antigen (PCNA) index correlates with the grade of cytologic atypia in well-differentiated early adenocarcinomas of the large intestine Pathol Int 45 359–65 Occurrence Handle1:STN:280:DyaK2MznsF2gtg%3D%3D Occurrence Handle7647932 Occurrence Handle10.1111/j.1440-1827.1995.tb03469.x

    Article  CAS  PubMed  Google Scholar 

  31. M Ono M Sakamoto Y Ino et al. (1996) ArticleTitleCancer cell morphology at the invasive front and expression of cell adhesion-related carbohydrate in the primary lesion of patients with colorectal carcinoma with liver metastasis Cancer 78 1179–86 Occurrence Handle10.1002/(SICI)1097-0142(19960915)78:6<1179::AID-CNCR3>3.0.CO;2-5 Occurrence Handle1:STN:280:DyaK28visVCitw%3D%3D Occurrence Handle8826938

    Article  CAS  PubMed  Google Scholar 

  32. RJ Schlemper RH Riddell Y Kato et al. (2000) ArticleTitleThe Vienna classification of gastrointestinal epithelial neoplasia Gut 47 251–5 Occurrence Handle10.1136/gut.47.2.251 Occurrence Handle1:STN:280:DC%2BD3cvgsVWjsA%3D%3D Occurrence Handle10896917

    Article  CAS  PubMed  Google Scholar 

  33. HS Cooper LM Deppisch EI Kahn et al. (1998) ArticleTitlePathology of the malignant colorectal polyp Hum Pathol 29 15–26 Occurrence Handle10.1016/S0046-8177(98)90385-9 Occurrence Handle1:STN:280:DyaK1c7gsFyktg%3D%3D Occurrence Handle9445129

    Article  CAS  PubMed  Google Scholar 

  34. K Hase C Shatney D Johnson M Trollope M Vierra (1993) ArticleTitlePrognostic value of tumor “budding” in patients with colorectal cancer Dis Colon Rectum 36 627–35 Occurrence Handle1:STN:280:DyaK3szltFGjsA%3D%3D Occurrence Handle8348847

    CAS  PubMed  Google Scholar 

  35. M Martin P Pujuguet F Martin (1996) ArticleTitleRole of stromal myofibroblasts infiltrating colon cancer in tumor invasion Pathol Res Pract 192 712–7 Occurrence Handle1:CAS:528:DyaK28XlvVKls7g%3D Occurrence Handle8880872

    CAS  PubMed  Google Scholar 

  36. S Ban K Kamada N Mitsuki et al. (2000) ArticleTitlePhenotypic change of muscularis mocosae in early invasive colorectal adenocarcinoma J Clin Pathol 53 878–81 Occurrence Handle10.1136/jcp.53.11.878 Occurrence Handle1:STN:280:DC%2BD3M7gsVaitQ%3D%3D Occurrence Handle11127276

    Article  CAS  PubMed  Google Scholar 

  37. T Hasegawa T Hirose AG Ayala et al. (2001) ArticleTitleAdult neuroblastoma of the retroperitoneum and abdomen: clinicopathologic distinction from primitive neuroectodermal tumor Am J Surg Pathol 25 918–24 Occurrence Handle11420463 Occurrence Handle1:STN:280:DC%2BD3MzoslGruw%3D%3D

    PubMed  CAS  Google Scholar 

  38. K Kitajima T Fujimori S Fujii et al. (2002) ArticleTitleThe criteria for grading Ip•Isp type submucosal invasive colorectal carcinomas, tentatively decided by the Japanese Society for Cancer of the Colon and Rectum (in Japanese with English abstract) Stomach and Intestine 37 1507–17

    Google Scholar 

  39. Y Sakai (2000) ArticleTitleIndication and limitation of the endoscopic electroresection (in Japanese) Gastroenterol Surg 23 1755–60

    Google Scholar 

  40. P Dell’Abate A Iosca A Galimberti P Piccolo P Soliani E Foggi (2001) ArticleTitleEndoscopic treatment of colorectal benign-appearing lesions 3 cm or larger: techniques and outcome Dis Colon Rectum 44 112–8 Occurrence Handle1:STN:280:DC%2BD38%2FnvVGjtA%3D%3D Occurrence Handle11805571

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Clinical Laboratory Division, National Cancer Center Hospital, Tokyo, Japan

    Kenji Tominaga M.D., Satoshi Nimura M.D. & Tadakazu Shimoda M.D.

  2. Division of Gastroenterology, Department of Medicine, Toho University School of Medicine, Ohashi Hospital, Tokyo, Japan

    Kenji Tominaga M.D. & Yoshihiro Sakai M.D.

  3. Pathology Division, National Cancer Center Research Institute, Tokyo, Japan

    Yukihiro Nakanishi M.D.

  4. Cancer Information and Epidemiology Division, National Cancer Center Research Institute, Tokyo, Japan

    Kimio Yoshimura M.D.

Authors
  1. Kenji Tominaga M.D.
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  2. Yukihiro Nakanishi M.D.
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  3. Satoshi Nimura M.D.
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  4. Kimio Yoshimura M.D.
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  5. Yoshihiro Sakai M.D.
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  6. Tadakazu Shimoda M.D.
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Correspondence to Tadakazu Shimoda M.D..

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Supported in part by a grant-in-aid for cancer research from the Ministry of Health and Welfare of Japan.

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Tominaga, K., Nakanishi, Y., Nimura, S. et al. Predictive Histopathologic Factors for Lymph Node Metastasis in Patients With Nonpedunculated Submucosal Invasive Colorectal Carcinoma. Dis Colon Rectum 48, 92–100 (2005). https://doi.org/10.1007/s10350-004-0751-4

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  • DOI: https://doi.org/10.1007/s10350-004-0751-4

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