Tomoyuki Nishimura1, Shiro Oka2, Shinji Tanaka3, Naoki Asayama4, Shinji Nagata4, Yuzuru Tamaru5, Toshio Kuwai5, Ken Yamashita3, Yuki Ninomiya3, Yasuhiko Kitadai6, Koji Arihiro7, Kazuya Kuraoka8, Mayumi Kaneko9, Fumio Shimamoto10, Kazuaki Chayama1. 1. Department of Gastroenterology and Metabolism, Hiroshima University Hospital, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8551, Japan. 2. Department of Gastroenterology and Metabolism, Hiroshima University Hospital, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8551, Japan. oka4683@hiroshima-u.ac.jp. 3. Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan. 4. Department of Gastroenterology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan. 5. Department of Gastroenterology, National Hospital Organization, Kure Medical Center and Chugoku Cancer Center, Kure, Japan. 6. Department of the Faculty of Human Culture and Science, Prefectural University of Hiroshima, Hiroshima, Japan. 7. Department of Anatomical Pathology, Hiroshima University Hospital, Hiroshima, Japan. 8. Department of Diagnostic Pathology, National Hospital Organization, Kure Medical Center and Chugoku Cancer Center, Kure, Japan. 9. Department of Pathology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan. 10. Faculty of Health Sciences, Hiroshima Shudo University, Hiroshima, Japan.
Abstract
PURPOSE: The Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines indicate lymphovascular invasion-evaluated by hematoxylin and eosin (HE) staining-as a surgical requirement after endoscopic submucosal dissection (ESD) in T1 colorectal carcinoma (CRC) patients; however, immunohistochemical evaluation may be superior. This study aimed to clarify the significance of immunohistochemical lymphovascular evaluation as an indicator for additional surgery of T1 CRC after ESD, and assessed the guidelines' adequacy, even when evaluating through immunostaining. METHODS: Patients with T1 CRC who underwent ESD were enrolled across three institutions between January 2012 and December 2017. Immunohistochemical lymphovascular evaluation was performed. Clinicopathological features, pathological evaluations, and surgery indications were recorded. Univariate and multivariate logistic regression identified risk factors for lymph node (LN) metastasis of T1 CRC after ESD. RESULTS: Among 370 patients with T1 CRC, recurrence, 5-year overall survival, and 5-year disease specific survival rates were 1.6%, 94.6%, and 99.5%, respectively. Six patients (1.6%) experienced recurrence, five of whom underwent additional surgery. Those with no risk factors did not exhibit recurrence. A total of 215 (58.1%) patients underwent additional surgery after ESD, 21 (9.7%) of whom exhibited LN metastasis. Among 16 patients who underwent additional surgery due to lymphovascular invasion, three (18.8%) had LN metastasis. Multivariate logistic regression analysis identified lymphatic invasion as a significant risk factor for LN metastasis (odds ratio 3.9, 95% confidence interval 1.0-14.6, P = 0.0421). CONCLUSIONS: The JSCCR guidelines have clinical validity, and immunohistochemical lymphatic evaluation findings potentially predict LN metastasis for T1 CRC after ESD.
PURPOSE: The Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines indicate lymphovascular invasion-evaluated by hematoxylin and eosin (HE) staining-as a surgical requirement after endoscopic submucosal dissection (ESD) in T1 colorectal carcinoma (CRC) patients; however, immunohistochemical evaluation may be superior. This study aimed to clarify the significance of immunohistochemical lymphovascular evaluation as an indicator for additional surgery of T1 CRC after ESD, and assessed the guidelines' adequacy, even when evaluating through immunostaining. METHODS:Patients with T1 CRC who underwent ESD were enrolled across three institutions between January 2012 and December 2017. Immunohistochemical lymphovascular evaluation was performed. Clinicopathological features, pathological evaluations, and surgery indications were recorded. Univariate and multivariate logistic regression identified risk factors for lymph node (LN) metastasis of T1 CRC after ESD. RESULTS: Among 370 patients with T1 CRC, recurrence, 5-year overall survival, and 5-year disease specific survival rates were 1.6%, 94.6%, and 99.5%, respectively. Six patients (1.6%) experienced recurrence, five of whom underwent additional surgery. Those with no risk factors did not exhibit recurrence. A total of 215 (58.1%) patients underwent additional surgery after ESD, 21 (9.7%) of whom exhibited LN metastasis. Among 16 patients who underwent additional surgery due to lymphovascular invasion, three (18.8%) had LN metastasis. Multivariate logistic regression analysis identified lymphatic invasion as a significant risk factor for LN metastasis (odds ratio 3.9, 95% confidence interval 1.0-14.6, P = 0.0421). CONCLUSIONS: The JSCCR guidelines have clinical validity, and immunohistochemical lymphatic evaluation findings potentially predict LN metastasis for T1 CRC after ESD.
Authors: S Tanaka; K Haruma; H Oh-E; S Nagata; Y Hirota; A Furudoi; T Amioka; Y Kitadai; M Yoshihara; F Shimamoto Journal: Oncol Rep Date: 2000 Jul-Aug Impact factor: 3.906
Authors: S Tanaka; K Haruma; C R Teixeira; S Tatsuta; N Ohtsu; Y Hiraga; M Yoshihara; K Sumii; G Kajiyama; F Shimamoto Journal: J Gastroenterol Date: 1995-12 Impact factor: 7.527
Authors: Y Egashira; T Yoshida; I Hirata; N Hamamoto; H Akutagawa; A Takeshita; N Noda; Y Kurisu; Y Shibayama Journal: Mod Pathol Date: 2004-05 Impact factor: 7.842