Ishikawa, H.; Fujii, H.; Koyama, F.; Mukougawa, T.; Matsumoto, H.; Kobayashi, T.; Kuniyasu, H.; Nakajima, Y.
April 2003
Gut;Apr2003 Supplement 1, Vol. 52, pA91
Academic Journal
Aim: It is difficult to estimate the adequacy of endoscopic resection for submucosal invasive colorectal carcinoma (SICC) because about 10% of patients with SICCs have nodal involvement. VEGF-C is suggested to nave an important role For tumour lymphangiogenesis and tumour sprouting has regained attention as an indicator of lymphatic invasion (LI). To investigate risk factors of nodal involvement in SICC, we have examined the relationship between nodal involvement and tumour status of VEGF expression and tumour sprouting along with clinicopathological factors. Methods: Sixty-eight consecutive patients with SICCs underwent either surgical or endoscopic resection between 1990 and 2001. Patients were aged between 38 and 80 years (median 65), 44 were male. 36 tumours were polypoid. Tumours were classified by the absolute amount of submucosal invasion both in their depth and width (depth; sm1 ≤ 0.5 mm, 0.5 < sm2 < 1.0 mm, 1.0 mm ≤ sm3, width; sma ≤ 1.0 mm, 1.0 < smb < 3.0 mm, 3.0 mm ≤ smc) and were immunohistochemically stained for VEGF-C and Cytokeratin 8/18. Results: Of 68 tumours 7 had nodal involvement. Among clinocopathologocal factors, the ratio of nodal involvement of polypoid tumours (1/35) was lower than that of non-polypoid (6/35; p = 0.044). Tumours were divided into sm1(14), sm2(29), sm3(25) in the depth, sma(18), smb(27), smc(23) in the width. There was no nodal involvement in sm1 and sm2a(6). As tumour invasion increased in depth and width, positive cases of LI, venous invasion (VI) and nodal involvement increased. VEGF-C expression showed positive correlation with LI, VI and nodal involvement and tumour sprouting showed positive correlation with LI and nodal involvement. Both VEGF-C expression (6/7, 85.7%) and tumour sprouting (5/7, 71.4%) showed high specificity for nodal involvement. Conclusion: VEGF-C expression and tumour sprouting are useful in predicting nodal involvement in SICC.


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