Correlation study on micrometastasis in circumferential resection margin of middle and low rectal cancer and clinical pathological features

doi:10.3877/cma.j.issn.1674-0793.2016.04.003

Abstract

Abstract:

Objective

To explore the expression of CK20, MMP-7, CDX2 and CDH17 on the micrometastasis in circumferential resection margin (CRM) of middle and low rectal cancer and the relationship between micrometastasis in CRM and clinical pathological characteristics.

Methods

Fifty cases of middle and low rectal cancer chosen from May to September 2014 were tested for CK20, MMP-7, CDX2 and CDH17 using immunohistochemistry. According to the micrometastasis in CRM, patients were divided into group A (with no micrometastases of the negative control group) and group B (with micrometastases of the positive group), and then group B were subdivided into group B1 (carcinoma invasion group) and group B2 (no carcinoma invasion group). Related clinical information and tumor recurrence were collected after the follow-up.

Results

The average distance from CRM was less than 0.1 cm, (1.4±0.7) cm, and (2.6±1.1) cm in Group B1, Group B2 and Group A and the difference was statistically significant (P<0.05). Compared with group A, TNM staging, lymphatic vascular invasion, nerve invasion and lymph node metastasis rate in Group B1 and Group B2 were higher, and tumor diameter was bigger with significant difference (P<0.05); when tumor diameter was more than 5 cm, there were 38.9% (7/18) in patients with CRMI and 55.7% patients had micrometastasis in CRM after undergoing TME. TNM stage, lymphatic vascular invasion, nerve invasion, lymph node metastasis rate and tumor size were related to micrometastasis in CRM.

Conclusions

Micrometastasis in CRM is an important factor of postoperative recurrence, and for patients with advanced pathological staging, lymphatic vessels and nerve invasion, especially when tumor diameter is more than 5 cm, it is important to test the micrometastasis in CRM.

Key words: Rectal neoplasms, Cytokines, Lymphatic metastasis, Immunohistochemistry, Pathology, clinical

Songsong Jiang, Gang Chen, Hongyan Wu, Liming Zheng, Kai Zhang. Correlation study on micrometastasis in circumferential resection margin of middle and low rectal cancer and clinical pathological features[J]. Chinese Archives of General Surgery(Electronic Edition), 2016, 10(04): 241-246.

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References 15

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病理特征		B组		A组(n=37)	χ²值		P值
病理特征		B1组(n=7)	B2组(n=6)	A组(n=37)	B2与A组	B1、B2、A组	B2与A组	B1、B2、A组
性别		?	?	?	0.438	2.770	0.508	0.250
?	男	3	5	26	?	?	?	?
?	女	4	1	11	?	?	?	?
平均年龄（岁， ± s）		63.2±3.6	57.1±4.5	59.2±5.7	1.009	1.680	0.315	0.423
?	<40	0	1	2	?	?	?	?
?	≥40	7	5	35	?	?	?	?
环周切缘距肿瘤距离(cm)		<0.1	1.4±0.7	2.6±1.1	-15.326	51.502	0.027	0.000
?	<0.1	7	0	0	?	?	?	?
?	0.1~1.0	0	3	10	?	?	?	?
?	>1.0	0	3	27	?	?	?	?
手术方式		?	?	?	0.715	0.837	0.398	0.658
?	TME+Dixon	6	6	33	?	?	?	?
?	TME+Miles	1	0	4	?	?	?	?
T分期		?	?	?	1.864	9.720	0.397	0.137
?	T1	0	0	2	?	?	?	?
?	T2	0	0	7	?	?	?	?
?	T3	6	6	28	?	?	?	?
?	T4	1	0	0	?	?	?	?
N分期		?	?	?	4.114	10.718	0.128	0.030
?	N0	1	1	21	?	?	?	?
?	N1	2	4	10	?	?	?	?
?	N2	4	1	6	?	?	?	?
TNM分期		?	?	?	3.959	7.853	0.266	0.028
?	Ⅰ期	0	0	6	?	?	?	?
?	Ⅱ期	1	1	15	?	?	?	?
?	Ⅲ期	6	5	15	?	?	?	?
?	Ⅳ期	0	0	1	?	?	?	?
分化程度		?	?	?	1.230	6.117	0.541	0.191
?	低	4	2	6	?	?	?	?
?	中	3	4	29	?	?	?	?
?	高	0	0	2	?	?	?	?
神经侵犯		?	?	?	4.388	16.066	0.036	0.000
?	是	7	4	9	?	?	?	?
?	否	0	2	28	?	?	?	?
淋巴脉管浸润		?	?	?	3.101	6.285	0.078	0.043
?	是	5	4	11	?	?	?	?
?	否	2	2	26	?	?	?	?
淋巴结转移		?	?	?	15.128	39.097	0.000	0.000
?	是	31	22	49	?	?	?	?
?	否	73	76	493	?	?	?	?
肿块直径(cm)		?	?	?	5.207	13.278	0.022	0.001
?	<5	1	2	29	?	?	?	?
?	≥5	6	4	8	?	?	?	?

病理特征		B组		A组(n=37)	χ²值		P值
病理特征		B1组(n=7)	B2组(n=6)	A组(n=37)	B2与A组	B1、B2、A组	B2与A组	B1、B2、A组
性别		?	?	?	0.438	2.770	0.508	0.250
?	男	3	5	26	?	?	?	?
?	女	4	1	11	?	?	?	?
平均年龄（岁， ± s）		63.2±3.6	57.1±4.5	59.2±5.7	1.009	1.680	0.315	0.423
?	<40	0	1	2	?	?	?	?
?	≥40	7	5	35	?	?	?	?
环周切缘距肿瘤距离(cm)		<0.1	1.4±0.7	2.6±1.1	-15.326	51.502	0.027	0.000
?	<0.1	7	0	0	?	?	?	?
?	0.1~1.0	0	3	10	?	?	?	?
?	>1.0	0	3	27	?	?	?	?
手术方式		?	?	?	0.715	0.837	0.398	0.658
?	TME+Dixon	6	6	33	?	?	?	?
?	TME+Miles	1	0	4	?	?	?	?
T分期		?	?	?	1.864	9.720	0.397	0.137
?	T1	0	0	2	?	?	?	?
?	T2	0	0	7	?	?	?	?
?	T3	6	6	28	?	?	?	?
?	T4	1	0	0	?	?	?	?
N分期		?	?	?	4.114	10.718	0.128	0.030
?	N0	1	1	21	?	?	?	?
?	N1	2	4	10	?	?	?	?
?	N2	4	1	6	?	?	?	?
TNM分期		?	?	?	3.959	7.853	0.266	0.028
?	Ⅰ期	0	0	6	?	?	?	?
?	Ⅱ期	1	1	15	?	?	?	?
?	Ⅲ期	6	5	15	?	?	?	?
?	Ⅳ期	0	0	1	?	?	?	?
分化程度		?	?	?	1.230	6.117	0.541	0.191
?	低	4	2	6	?	?	?	?
?	中	3	4	29	?	?	?	?
?	高	0	0	2	?	?	?	?
神经侵犯		?	?	?	4.388	16.066	0.036	0.000
?	是	7	4	9	?	?	?	?
?	否	0	2	28	?	?	?	?
淋巴脉管浸润		?	?	?	3.101	6.285	0.078	0.043
?	是	5	4	11	?	?	?	?
?	否	2	2	26	?	?	?	?
淋巴结转移		?	?	?	15.128	39.097	0.000	0.000
?	是	31	22	49	?	?	?	?
?	否	73	76	493	?	?	?	?
肿块直径(cm)		?	?	?	5.207	13.278	0.022	0.001
?	<5	1	2	29	?	?	?	?
?	≥5	6	4	8	?	?	?	?

基因检测		B1组(n=7)	B2组(n=6)	A组(n=37)	单因素显著性
KRAS第2外显子		?	?	?	0.342
?	12号密码子突变	2	2	10	?
?	13号密码子突变	2	0	3	?
?	未突变	3	4	24	?
NRAS		?	?	?	0.434
?	第2外显子突变	0	0	1	?
?	第3外显子突变	0	0	1	?
?	未突变	7	6	35	?
微卫星DNA稳定性		?	?	?	0.584
?	稳定	7	6	36	?
?	不稳定	0	0	1	?

基因检测		B1组(n=7)	B2组(n=6)	A组(n=37)	单因素显著性
KRAS第2外显子		?	?	?	0.342
?	12号密码子突变	2	2	10	?
?	13号密码子突变	2	0	3	?
?	未突变	3	4	24	?
NRAS		?	?	?	0.434
?	第2外显子突变	0	0	1	?
?	第3外显子突变	0	0	1	?
?	未突变	7	6	35	?
微卫星DNA稳定性		?	?	?	0.584
?	稳定	7	6	36	?
?	不稳定	0	0	1	?

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