Skip to main content
SpringerLink
Log in

Risikofaktoren der lymphogenen Metastasierung von kolorektalen pT1-Karzinomen

  • Übersichten
  • Published:
Der Pathologe Aims and scope Submit manuscript

Zusammenfasung

In den letzten Jahrzehnten hat sich die endoskopische Polypektomie kolorektaler Adenome gegenüber chirurgischen Verfahren durchgesetzt. Dies gilt auch für die kolorektalen Adenokarzinome mit Invasion der Submukosa (pT1). Es stellt sich die Frage, bei welcher Befundkonstellation primär eine chirurgische Therapie anzustreben ist. Ein sehr gutes Maß ist die Wahrscheinlichkeit von Lympknotenmetastasen, die es gegen das Operationsrisiko abzuwägen gilt.

Histologisch lassen sich die Adenokarzinome mit Infiltration der Submukosa in eine Niedrigrisikogruppe und in eine Hochrisikogruppe einteilen. Die klassischen Parameter für die Hochrisikokonstellation sind: Lymphgefäßeinbrüche, schlechter Differenzierungsgrad und die inkomplette Abtragung (R1-Situation). Neu hinzugekommene Risikofaktoren sind die Infiltration des unteren Drittels der Submukosa (sm3) und die hochgradige Dissoziation der Tumorzellen in der Invasionsfront. In der Literatur und in einer eigenen Auswertung können wir zeigen, dass bei Nachweis dieser neuen Parameter das Risiko für Lymphknotenmetastasen signifikant ansteigt.

Abstract

During the last 20 years, endoscopic removal of colorectal adenoma has become widely accepted as a replacement for removal by open surgery. Even colorectal adenocarcinomas are not excluded. The key question is when surgical treatment should still be preferred over endoscopic removal as the primary treatment. One good indicator is the frequency of lymph node metastasis, which should be compared with the overall risk involved in the surgical procedure itself.

Histological examination allows subdivision of early colorectal adenocarcinomas into low-risk and high-risk groups. Classical parameters for a high-risk situation are lymphatic invasion, poor differentiation, and incomplete removal (R1). Additional risk factors that have recently been discussed are infiltration into the lower third of the submucosal layer (sm3) and dissociation (budding) of the tumour cells at the invasion front. Drawing on the literature and an analysis of our own patients, we demonstrate a positive correlation between these new markers and an elevated risk of the presence of lymph node metastasis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1.
Abb. 2.
Abb. 3.
Abb. 4.

Literatur

  1. Breiteneder-Geleff S, Soleiman A, Horvat R, Amann G, Kowalski H, Kerjaschki D (1999). Podoplanin--a specific marker for lymphatic endothelium expressed in angiosarcoma. Verh Dtsch Ges Pathol 83:270–275

    CAS  PubMed  Google Scholar 

  2. Compton C, Fenoglio-Preiser CM, Pettigrew N, Fleding LP (2000). American Joint Committee on Cancer prognostic factors consensus conference colorectal working group. Cancer 88:1739–1757

    Article  CAS  PubMed  Google Scholar 

  3. Dirschmid K, Lang A, Mathis G, Haid A, Hansen M (1996). Incidence of extramural venous invasion in colorectal carcinoma: findings with a new technique. Hum Pathol 27:1227–1230

    CAS  PubMed  Google Scholar 

  4. Gabbert H (1985). Mechanisms of tumor invasion: evidence from in vivo observations. Cancer Metastasis 4:293–309

    CAS  Google Scholar 

  5. Hager T, Gall FP, Hermanek P(1983). Local excision of cancer of the rectum. Dis Colon Rectum 26:149–151

    CAS  PubMed  Google Scholar 

  6. Haggitt RC, Glotzbach RE, Soffer EE, Wruble LD (1985). Prognostic factors in colorectal carcinomas arising in adenomas: implications for lesions removed by endoscopic polypectomy. Gastroenterology 89:328–336

    Google Scholar 

  7. Hase K, Shatney CH, Mochizuki H et al., Johnson DL, Tamakuma S, Vierra M, Trollope M (1995). Long-term results of curative resection of "minimally invasive" colorectal cancer. Dis Colon Rectum 38:19–26

    CAS  PubMed  Google Scholar 

  8. Hermanek P (1978). A pathologist's point of view on endoscopically removed polyps of colon and rectum. Acta Hepatogastroenterol (Stuttg) 25:169–170

    Google Scholar 

  9. Herrero-Jimenez P, Tomita-Mitchell A, Furth EE, Morgenthaler S, Thilly WG (2000) Population risk and physiological rate parameters for colon cancer. The union of an explicit model for carcinogenesis with the public health records of the United States. Mutat Res 447:73–116

    Article  CAS  PubMed  Google Scholar 

  10. Imai T (1954). The growth of human carcinoma: a morphological analysis. Fukuoka Igaku Zasshi 45:72–102

    Google Scholar 

  11. Jass JR, Atkin WS, Cuzick J, Bussey HJ, Morson BC, Northover JM, Todd IP (1986). The grading of rectal cancer: historical perspectives and a multivariate analysis of 447 cases. Histopathology 10:437–459

    CAS  PubMed  Google Scholar 

  12. Kikuchi R, Takano M, Takagi K, Fujimoto N, Nozaki R, Fujiyoshi T, Uchida Y (1995). Management of early invasive colorectal cancer. Risk of recurrence and clinical guidelines. Dis Colon Rectum 38:1286–1295

    CAS  PubMed  Google Scholar 

  13. Krasuna MJ; Flancbaum L, Cody RP, Shneibaum S, Ben AG (1988). Vascular and neural invasion in colorectal carcinoma: incidence and prognostic significance. Cancer 61:1018–1023

    PubMed  Google Scholar 

  14. Kudo S (1993). Endoscopical mucosal resection of flat and depressed types of early colorectal cancer. Endoscopy 25:455–461

    CAS  PubMed  Google Scholar 

  15. Mentzel T, Kutzner H (2002). Lymphgefäßtumoren der Haut und des Weichgewebes. Pathologe 23:118–127

    Article  CAS  PubMed  Google Scholar 

  16. Minamoto T, Mai M, Ogino T, Sawaguchi K, Ohta T, Fujimoto T, Takahashi Y (1993). Early invasive colorectal carcinomas metastatic to the lymph node with attention to their nonpolypoid development. Am J Gastroenterol 88:1035–1039

    CAS  PubMed  Google Scholar 

  17. Minsky BD, Mies C, Recht A, Rich TA, Chaffey JT (1988). Resectable adenocarcinoma of the rectosigmoid and rectum. II. The influence of blood vessel invasion. Cancer 61:1417–1424

    CAS  PubMed  Google Scholar 

  18. Minsky BD, Mies C, Rich TA, Recht A (1989). Lymphatic vessel invasion is an independent prognostic factor for survival in colorectal cancer. Int J Radiat Oncol Biol Phys 17:311–308

    Google Scholar 

  19. Morodomi T, Isomoto H, Shirouzu K, Kakegawa K, Irie K, Morimatsu M (1989). An index for estimating the probability of lymph node metastasis in rectal cancers. Cancer 63:539–543

    CAS  PubMed  Google Scholar 

  20. Nascimbeni R, Burgart LJ, Nivatvongs S, Larson DR (2002). Risk of lymph node metastasis in T1 carcinoma of the colon and rectum. Dis Colon Rectum 45:200–206

    PubMed  Google Scholar 

  21. Nishi M, Moriyasu F (2002). Clinicopathological study for reevaluation of the depth of submucosal invasion and histological classification of early colorectal cancer. Nippon Shokakibyo Gakkai Zasshi 99:769–778

    PubMed  Google Scholar 

  22. Nivatvongs S (1986). Complications in colonoscopic polypectomy: an experience with 1555 polypectomies. Dis Colon Rectum 29:825–830

    CAS  PubMed  Google Scholar 

  23. Nusko G, Mansman U, Partzsch U et al. (1997). Invasive carcinoma in colorectal adenomas: multivariate analysis of patient and adenoma characteristics. Endoscopy 29:626–631

    CAS  PubMed  Google Scholar 

  24. Okuyama T, Oya M, Ishikawa H (2002). Budding as a risk factor for lymph node metastasis in pT1 or pT2 well-differentiated colorectal adenocarcinoma. Dis Colon Rectum 45:628–634

    PubMed  Google Scholar 

  25. Ono M, Sakamoto M, Ino Y, Moriya Y, Sugihara K, Muto T, Hirohashi S (1996).Cancer 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 78:1179–1186

    Article  CAS  PubMed  Google Scholar 

  26. Ooi BS, Ho YH, Eu KW, Seow Choen F (2001). Primary colorectal signet-ring cell carcinoma in Singapore. ANZ J Surg 71:703–706.

    Article  CAS  PubMed  Google Scholar 

  27. Pollard CW, Nivatvongs S, Rojanasakul A, Reiman HM, Dozois RR (1992). The Fate of patients following polypectomy alone for polyps containing invasive carcinoma. Dis Colon Rectum 35:933–937

    CAS  PubMed  Google Scholar 

  28. Shinya H, Wolff WI (1979). Morphology, anatomic distribution, and cancer potential of colonic polyps: an analysis of 7000 polyps endoscopically removed. Ann Surg 190:679–683

    CAS  PubMed  Google Scholar 

  29. Sternberg A, Amar M, Alfici R, Groisman G (2002).Conclusions from a study of venous invasion in stage IV colorectal adenocarcinoma. J Clin Pathol 55:17–21

    CAS  PubMed  Google Scholar 

  30. Wittekind Ch, Meyer HJ, Bootz F (Hrsg) (2002) TNM Klassifikation maligner Tumoren. 6. Auflage, Springer, Berlin Heidelberg New York

  31. Christie JP (1984) Malignant colon polyps--cure by colonoscopy or colectomy? Am J Gastroenterol 79/7:543–547

  32. Coverlizza S, Risio M, Ferrari A, Fenoglio-Preiser CM, Rossini FP (1989) Colorectal adenomas containing invasive carcinoma. Pathologic assessment of lymph node metastatic potential. Cancer 64/9:1937–1947

  33. Hackelsberger A, Frühmorgen P, Weiler H, Heller T, Seeliger H, Junghanns K (1995) Endoscopic polypectomy and management of colorectal adenomas with invasive carcinoma. Endoscopy 27/2:153–158

  34. Hermanek P (1991) Prognosis of colorectal cancers. Fortschr Med 109/8:187–188

  35. Huddy SP, Husband EM, Cook MG, Gibbs NM, Marks CG, Heald RJ (1993) Lymph node metastases in early rectal cancer. Br J Surg 80/11:1457–1458

  36. Jung M, Meier HJ, Mennicken C, Barth HO, Manegold BC (1988) Endoscopic and surgical therapy of malignant colorectal polyps. Z Gastroenterol 26/3:179–184

  37. Masaki T, Muto T (2000) Predictive value of histology at the invasive margin in the prognosis of early invasive colorectal carcinoma. J Gastroenterol 35/3:195–200

  38. Moreira LF, Iwagaki H, Inoguchi K, Hizuta A, Sakagami K, Orita K (1992) Assessment of lymph node metastasis and vessel invasion in early rectal cancer. Acta Med Okayama 46/1:7–10

  39. Morson BC, Whiteway JE, Jones EA, Macrae FA, Williams CB (1984) Histopathology and prognosis of malignant colorectal polyps treated by endoscopic polypectomy. Gut 25/5:437–444

  40. Muto T, Sawada T, Sugihara K (1991) Treatment of carcinoma in adenomas. World J Surg 15/1:35–40

  41. Nivatvongs S (2000) Surgical management of early colorectal cancer. World J Surg 24/9:1052–1055

  42. Stolte M, Hermanek P (1990) Malignant polyps-pathological factors governing clinical management. In: Williams GT (ed) Gastrointestinal pathology, current topics in pathology. Springer, Berlin Heidelberg New York, pp 277–293

  43. Sugihara K, Muto T, Morioka Y (1989) Management of patients with invasive carcinoma removed by colonoscopic polypectomy. Dis Colon Rectu 32/10:829–834

  44. Tanaka S, Haruma K, Teixeira CR et al. (1995) Endoscopic treatment of submucosal invasive colorectal carcinoma with special reference to risk factors for lymph node metastasis. J Gastroenterol 30/6:710–717

  45. Stolte M (1992) Gastroenterologie und Pathologie: Wann, wo und wie punktieren und biopsieren? In: Frühmorgen P (Hrsg) Gastroenterologische Endoskopie. Ein Leitfaden zur Diagnostik und Therapie, 4. Aufl. Springer, Berlin Heidelberg New York, S 67–92

Download references

Author information

Authors and Affiliations

  1. Institut für Pathologie, Klinikum Bayreuth, Bayreuth

    P. Deinlein & M. Stolte

  2. Institut für Medizininformatik, Biometrie und Epidemiologie, Universität Erlangen-Nürnberg, Erlangen

    U. Reulbach

  3. Institut für Pathologie, Universität Magdeburg, Leipzigerstraße 44, 39120 , Magdeburg

    M. Vieth

Authors
  1. P. Deinlein
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. U. Reulbach
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Stolte
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. Vieth
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Vieth.

Additional information

Herrn Professor Dr. med. Volker Becker zum 80. Geburtstag gewidmet.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Deinlein, P., Reulbach, U., Stolte, M. et al. Risikofaktoren der lymphogenen Metastasierung von kolorektalen pT1-Karzinomen. Pathologe 24, 387–393 (2003). https://doi.org/10.1007/s00292-003-0632-y

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00292-003-0632-y

Schlüsselwörter

Keywords

Search

Navigation