BACKGROUND: The validity of the histological criteria in deciding additional bowel resection after local excision of T2 rectal carcinomas is questioned. METHODOLOGY: In 72 T2 colorectal carcinomas resected by major surgery, the associations between lymph node metastasis (LNM) and clinicopathologic parameters were examined statistically, a prediction formula for LNM was constructed and decision analysis was attempted. RESULTS: Multivariate analysis showed that female gender and a greater number of tumor budding were significantly associated with LNM. The probability of LNM can be calculated as follows; Z = 0.037 x (budding number) + 2.08 x (SEX; male, 1; female, 2) - 5.736; Probability = 1/1 + e(-Z). When a 75-year-old patient has pulmonary complications, the operative risk is assumed to be over 2%. If a number of tumor budding is 0, the risk of LNM is calculated as 2.4% in a male and 17.1% in a female patient. On the assumption that the risk of liver metastasis is half of that of LNM, and the salvageabilities after LNM and liver metastasis are 20% and 50%, respectively, observation policy is justified for a male patient, whereas additional surgery should be undertaken for a female patient. CONCLUSIONS: A number of tumor budding may be useful for determining the individualized treatment of T2 rectal carcinomas.
BACKGROUND: The validity of the histological criteria in deciding additional bowel resection after local excision of T2 rectal carcinomas is questioned. METHODOLOGY: In 72 T2 colorectal carcinomas resected by major surgery, the associations between lymph node metastasis (LNM) and clinicopathologic parameters were examined statistically, a prediction formula for LNM was constructed and decision analysis was attempted. RESULTS: Multivariate analysis showed that female gender and a greater number of tumor budding were significantly associated with LNM. The probability of LNM can be calculated as follows; Z = 0.037 x (budding number) + 2.08 x (SEX; male, 1; female, 2) - 5.736; Probability = 1/1 + e(-Z). When a 75-year-old patient has pulmonary complications, the operative risk is assumed to be over 2%. If a number of tumor budding is 0, the risk of LNM is calculated as 2.4% in a male and 17.1% in a female patient. On the assumption that the risk of liver metastasis is half of that of LNM, and the salvageabilities after LNM and liver metastasis are 20% and 50%, respectively, observation policy is justified for a male patient, whereas additional surgery should be undertaken for a female patient. CONCLUSIONS: A number of tumor budding may be useful for determining the individualized treatment of T2 rectal carcinomas.
Authors: Sean C Glasgow; Joshua I S Bleier; Lawrence J Burgart; Charles O Finne; Ann C Lowry Journal: J Gastrointest Surg Date: 2012-01-19 Impact factor: 3.452
Authors: Michael S Landau; Steven M Hastings; Tyler J Foxwell; James D Luketich; Katie S Nason; Jon M Davison Journal: Mod Pathol Date: 2014-04-25 Impact factor: 7.842