Association between pathological T1 colorectal cancer with lymphoid follicular replacement and risk of lymph node metastasis.

IF 3.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Journal of Gastroenterology and Hepatology Pub Date : 2024-09-22 DOI:10.1111/jgh.16745

Atsushi Inaba, Hiroaki Ikematsu, Motohiro Kojima, Naoya Sakamoto, Masashi Wakabayashi, Hironori Sunakawa, Keiichiro Nakajo, Tatsuro Murano, Tomohiro Kadota, Kensuke Shinmura, Tomonori Yano

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引用次数: 0

Abstract

Background and aim: Endoscopic resection (ER) is widely performed to treat early colorectal cancer. However, additional surgery for pathological T1 colorectal cancer (pT1CRC) after ER is controversial because of the imprecise prediction of lymph node metastasis (LNM). Recently, several patients of pT1CRC with lymphoid follicular replacement (LFR) without LNM have been reported. This study aimed to investigate the clinicopathological features and risk of LNM in patients with pT1CRC with LFR.

Methods: We retrospectively analyzed patients who underwent ER or surgical resection and were diagnosed with pT1CRC between January 2010 and December 2020. We defined pT1CRC with LFR as the replacement of a part of the lymphoid follicular component within the submucosal area by adenocarcinoma, with no invasion into other submucosal areas.

Results: Among the 600 eligible patients, the incidence rate of pT1CRC with LFR was 6.7% (40/600). Patients with pT1CRC with LFR represented 14.3% (37/258) of the endoscopically treated patients and 0.9% (3/342) of the surgically treated patients. For patients with pT1CRC with LFR, 80.0% (32/40) had flat and depressed lesions, and 35.0% (14/40) had submucosal invasion depth ≥1000 μm. Patients with pT1CRC with LFR had negative lymphovascular invasion, differentiated type, and budding grade 1. In the median follow-up of 61 months, patients with pT1CRC with LFR had no LNM.

Conclusions: The presence of LFR in pT1CRC may be associated with a low risk of LNM. In patients with pT1CRC with LFR, follow-up without additional surgery is possible even if the submucosal invasion depth is ≥1000 μm.

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病理 T1 结直肠癌淋巴滤泡替代与淋巴结转移风险之间的关系

背景和目的：内镜下切除术（ER）被广泛用于治疗早期结直肠癌。然而，由于对淋巴结转移（LNM）的预测并不精确，在内镜切除术后对病理 T1 结直肠癌（pT1CRC）进行额外手术还存在争议。最近，有报道称一些 pT1CRC 患者伴有淋巴滤泡替代（LFR），但无淋巴结转移。本研究旨在探讨伴有淋巴滤泡替代的pT1CRC患者的临床病理特征和发生LNM的风险：我们回顾性分析了2010年1月至2020年12月期间接受ER或手术切除并确诊为pT1CRC的患者。我们将pT1CRC伴LFR定义为粘膜下区域的部分淋巴滤泡成分被腺癌取代，且未侵犯其他粘膜下区域：在600名符合条件的患者中，pT1CRC伴LFR的发生率为6.7%（40/600）。pT1CRC伴LFR患者占内镜治疗患者的14.3%（37/258），占手术治疗患者的0.9%（3/342）。在 pT1CRC 伴 LFR 患者中，80.0%（32/40）的病灶平坦凹陷，35.0%（14/40）的粘膜下侵犯深度≥1000 μm。伴有LFR的pT1CRC患者淋巴管侵犯阴性、分化型和萌芽1级。在中位61个月的随访中，伴有LFR的pT1CRC患者没有出现LNM：结论：pT1CRC患者出现LFR可能与低LNM风险有关。对于伴有 LFR 的 pT1CRC 患者，即使粘膜下侵犯深度≥1000 μm，也可以不进行额外手术进行随访。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Gastroenterology and Hepatology 医学-胃肠肝病学

CiteScore

7.90

自引率

2.40%

发文量

326

审稿时长

2.3 months

期刊介绍： Journal of Gastroenterology and Hepatology is produced 12 times per year and publishes peer-reviewed original papers, reviews and editorials concerned with clinical practice and research in the fields of hepatology, gastroenterology and endoscopy. Papers cover the medical, radiological, pathological, biochemical, physiological and historical aspects of the subject areas. All submitted papers are reviewed by at least two referees expert in the field of the submitted paper.