Extent Of Lymph Node Metastasis Research Articles

Comparison Between 3-T Magnetic Resonance Imaging and Multi-Detector Row Computed Tomography for the Preoperative Evaluation of Rectal Cancer

To compare prospectively between 3-T magnetic resonance imaging (MRI) and multidetector row computed tomography (MDCT) for the local staging of rectal cancer. During a recent 8-month period, both 3-T MRI with a phased array coil and MDCT scanner were used to preoperatively examine 31 consecutive patients. Preoperatively, the 3 experienced reviewers independently assessed the MRI and MDCT findings for the depth of tumor invasion into the rectal wall (T). Regional lymph node metastasis (N) was assessed by the 3 reviewers working in consensus. For T staging, we used a modified T staging (<or=T2, T3, and T4 staging). The results of the MRI and MDCT findings were compared based on the diagnosis of the resected specimens. At histopathology, T1 was identified in 8 patients, T2 in 6, and T3 in 17 patients. The sensitivity, specificity, and accuracy for T2 staging or less between MRI and MDCT were 93% and 79%, 88% and 76%, and 91% and 77%, respectively. The sensitivity, specificity, and accuracy for T3 between MRI and MDCT were 92% and 73%, 93% and 83%, and 92% and 78%, respectively; there was a statistically significant difference for the T2 and T3 staging or less (P < 0.01). For N staging, MRI and CT can predict accurately in 88% and 77%, respectively (P > 0.05). For local staging of rectal cancer, 3-T MRI is more accurate than MDCT for determining the depth of tumor invasion and the extent of lymph node metastasis.

Prognostic Significance of Pathologic Nodal Status in Patients with Resected Pancreatic Cancer

BackgroundThe purpose of this study was to evaluate the significance of pathologic nodal assessment and extent of nodal metastases on patient outcome in patients with pancreatic adenocarcinoma. Materials and MethodsA prospectively maintained pancreatic cancer database was reviewed, and 696 consecutive patients were identified who underwent resection for pancreatic adenocarcinoma between 1995 and 2005. Overall survival was compared to lymph node (LN) status, absolute number of pathologically assessed LN, and LN ratio expressed as the number of positive LN to the total LN assessed. ResultsOf the 696 patients, 598 (86%) had pancreaticoduodenectomy (PD), and 96 (14%) had distal pancreatectomy (DP). For all patients, median follow-up was 13 months (range, 0–122 months), and estimated 5-year survival was 16%. A total of 243 (35%) patients were LN-negative (N0) and had a median survival of 27 months. When assessed as a continuous variable, the number of pathologically assessed LN did not correlate with survival for N0 patients undergoing either PD or DP. The median survival for the 453 patients with node-positive (N1) disease was 16 months. When analyzed as a continuous variable, the absolute number of positive LNs was a significant predictor of survival for N1 patients with a linear relationship up to eight positive LNs. LN ratio, as a continuous variable, also predicted survival with a linear relationship up to a ratio of 0.35. A ratio of 0.18 was associated with a 19-month median survival and served as the best cutoff, p < 0.01. ConclusionsThe absolute number of positive LNs and LN ratio are strong predictors of survival for patients with node-positive pancreatic adenocarcinoma. Inadequate surgical lymphadenectomy or pathologic LN assessment understages node-negative patients.

Extent of Routine Central Lymph Node Dissection With Small Papillary Thyroid Carcinoma

The indications for and extent of routine lymph node dissection in patients with papillary thyroid carcinoma (PTC) are unclear. The aim of this study was to investigate the association between the extent of central lymph node dissection (CLND) and the therapeutic effects and potential risks in patients with a small PTC. A total of 103 patients with a PTC <2 cm who underwent total thyroidectomy with routine CLND were divided into those who underwent routine bilateral CLND (group I) and those with ipsilateral CLND (group II). Therapeutic efficacy was evaluated by the extent of lymph node metastasis and postthyroidectomy serum thyroglobulin concentration. Patients with postoperative symptomatic hypocalcemia were considered to have postoperative hypoparathyroidism and received calcium/vitamin D therapy. Altogether, 12 of 21 patients (57.1%) in group I and 48 of 75 (64.0%) in group II had postthyroidectomy serum thyroglobulin concentrations <1.0 ng/ml; furthermore, 17 of 21 (81.0%) in group I and 60 of 75 (80.0%) in group II had concentrations <2.0 ng/ml. Hypocalcemia symptoms were identified in 12 of 25 patients (48.0%) in group I and in 16 of 78 (20.5%) in group II (p = 0.009). The extent of the CLND did not influence the therapeutic effects in patients with small PTCs, but those who underwent bilateral CLND showed an increased rate of transient hypoparathyroidism. These findings indicate that the more conservative routine CLND is as safe as more extensive CLND for patients with a small PTC.

Association of Tyrosine PRL-3 Phosphatase Protein Expression with Peritoneal Metastasis of Gastric Carcinoma and Prognosis

In gastric carcinoma, high expression of PRL-3, a protein tyrosine phosphatase, is associated with lymph node metastasis. We studied the relationship between PRL-3 expression and peritoneal metastasis in gastric carcinoma. Immunohistochemical analysis using the anti-PRL-3 antibody was done in 639 patients with gastric carcinoma including 89 with peritoneal metastases. We then compared the clinicopathologic characteristics of the PRL-3-positive and PRL-3-negative carcinomas. PRL-3 was expressed in 70.4% of the primary gastric carcinomas overall; in 80.9% of the cancers with peritoneal metastasis and in 68.7% of those without peritoneal metastasis (P = 0.020). PRL-3 expression was higher in peritoneal metastasis than in the corresponding primary gastric cancers (P = 0.028). PRL-3 expression was correlated with tumor stage (coefficient = 0.343, P = 0.01) and cancer progression, including lymphatic invasion (coefficient = 0.325, P = 0.02), extent of lymph node metastasis (coefficient = 0.322, P = 0.01), and peritoneal metastasis (coefficient = 0.316, P = 0.03). Patients who were PRL-3-negative had a better survival rate than those who were PRL-3-positive at all stages (stage I: log-rank P = 0.046, Wilcoxon P = 0.048; stage II: log-rank P = 0.035, Wilcoxon P = 0.041; stage III: log-rank P = 0.027, Wilcoxon P = 0.033; stage IV: log-rank P = 0.032, Wilcoxon P = 0.030). Peritoneal metastasis appears to be correlated with PRL-3 expression, tumor stage, lymphatic invasion, and extent of lymph node metastasis. PRL-3 expression was negatively correlated with prognosis in patients with gastric cancer.

Role of Lymph Node Dissection in Primary Surgery for Thyroid Cancer

The preoperative evaluation of the clinically N0 neck and the operative management of cervical lymph nodes in patients with papillary and medullary thyroid cancer remains controversial. The appreciation that even patients with low-risk disease have a significant risk for recurrence has generated interest in a more comprehensive preoperative evaluation of the neck and has renewed debate on the extent of lymphadenectomy at the time of thyroidectomy. The authors recommend using preoperative ultrasound before thyroidectomy for all patients with thyroid cancer and before any subsequent surgeries for recurrent disease to identify the extent of lymph node metastases and thereby facilitate complete surgical removal of all gross disease in the neck. The optimal surgical procedure for removing cervical lymphadenopathy is compartment-oriented neck dissection based on the findings from preoperative ultrasound.

Gynecologic Oncology Group risk groups for vulvar carcinoma: Improvement in survival in the modern era

Objective Patients with vulvar cancer were stratified into risk groups for survival based on surgicopathologic findings from a prospective study conducted by the Gynecologic Oncology Group from 1977–1984. The purpose of this study is to reassess these risk groups in patients treated in an era of contemporary management. Methods Patients with vulvar carcinoma were identified from 1990–2005 for retrospective analysis. Charts were abstracted for clinical, histopathologic and surgical data, and patients stratified into four risk groups for survival based on the clinical size of tumor and extent of lymph node metastasis. Univariate and multivariate characteristics were evaluated and 5-year survival determined by Kaplan–Meier method. Results 175 patients were identified that underwent surgical management with a median age at diagnosis of 59.9 years. Stage distribution included: I ( n = 89, 51%), II ( n = 53, 30%), III ( n = 29, 17%), and IV ( n = 4, 2%). Stratification into risk groups included: minimal ( n = 89, 51%), low ( n = 69, 40%), intermediate ( n = 11, 6%), and high ( n = 6; 3%). The survival rate was 100%, 97%, 82% and 100%, respectively, at median follow-up of 54.5 months. Comparatively, the survival rates for historic groups were 97.9%, 87.4%, 74.8% and 29.0%. Using multivariate analysis, age ( p = 0.04) and lymph node metastasis ( p = 0.009) were predictive of survival. Conclusions Survival among the minimal and low risk groups is preserved in spite of less radical surgery. 5-year survival rate for intermediate and high risk patients also appears to be improved. This is likely a result of advancement in adjuvant chemo-radiation and a younger patient population that presents with less advanced disease.

Classification of Lymph Node Metastases from Gastric Cancer: Comparison between N-Site and N-Number Systems. Our Experience and Review of the Literature

The tumor, node, metastasis (TNM) system has become the principal method for assessing the extent of disease, determining prognosis in gastric cancer patients, and affecting the therapy strategies. The extent of lymph node metastasis is the most important prognostic factor. The aim of this study was to compare the N-classifications of the 4th and the 5th-6th TNM editions and to evaluate retrospectively the prognostic value of the 2002 TNM edition. We evaluated 344 patients who underwent curative total or subtotal gastrectomy. Nodal involvement was detected in 221 (64%) patients. Median follow-up period was 76 months. Thirty per cent of the old N1 patients were reclassified as pN2 (18.5%) and pN3 (11.3%). Eighty-eight per cent of the old N2 patients were reclassified as pN1 (75%) and pN3 (13.7%). In reclassifying the patients, statistically significant changes were reported between 1987 and 2002 TNM stage grouping, mainly in stage IIIB and IV. The 5-year survival rate per stage group did not statistically differ between the 4th and the 5th-6th editions, although a diminutive trend was registered in the IIIA stage. pTNM stage, nodal numerical stage, nodal topographical stage, and depth of tumor invasion resulted in significantly independent prognostic factors. Our data confirm the simplicity and easy application of the new stadiation and the better prognostic stratification of the N-stage. The pN3 group showed a worse prognosis independent of location. On the other hand, prognostic value of pN1 and pN2 stage is lower, probably depending on lymph node location. In multivariate analysis, the difference between old and new TNM staging is low. Hence, we suggest comparing lymph node location and number in larger series. In our series, in pT1 tumors, neither pN2 nor pN3 involvement was found. Hence, in our opinion, for correct N-staging, 10 lymph nodes in early gastric cancer and at least 16 in the other pT-stages seem sufficient for a real pN0 stadiation.

High PRL-3 expression in human gastric cancer is a marker of metastasis and grades of malignancies: an in situ hybridization study

Phosphatase of regenerating liver (PRL)-3, encoding a 22-kD low molecular weight tyrosine phosphatase, has been reported to be associated with metastasis of colorectal carcinoma. We assessed the levels of PRL-3 mRNA expression to know whether its up-regulation was involved in progression and metastasis of gastric carcinoma. Levels of PRL-3 expression in 94 human gastric adenocarcinomas and 54 matched lymph node metastases were detected by in situ hybridization and compared with clinicopathological characteristics including prognosis. High PRL-3 expression was detected in 36.2% of primary gastric carcinoma (with nodal metastasis, 55.6%; without nodal metastasis, 10%; P < 0.001) and in 74.1% of lymph node metastases. The incidence of high PRL-3 expression in lymph node metastasis was significantly higher than in primary tumors (P < 0.044). Moreover, high expression of PRL-3 was closely associated with tumor size, lymphatic invasion, venous invasion, extent of lymph node metastasis, and tumor stage. These results suggest that high PRL-3 expression may participate in the progression and metastasis of gastric carcinoma. PRL-3 might be a novel molecular marker for aggressive gastric cancer.

Retrospective analysis of outcome in 63 gallbladder carcinoma patients after radical resection

The aim of this study was to evaluate factors influencing outcome in gallbladder carcinoma after radical resection, in order to identify those patients benefiting from radical surgery. Sixty-three patients (13 pT1, 28 pT2, 14 pT3, and 8 pT4) who underwent surgical resection for gallbladder carcinoma were retrospectively reviewed. Correlations were sought between survival and factors such as the depth of invasion (pT) including the status of infiltration of the hepatoduodenal ligament (pBinf) and liver bed (pHinf), the extent of lymph node metastasis, and other pathologic factors. Multivariate analysis showed that pBinf, pHinf, and lymph node metastasis were significant prognostic factors. We also analyzed survival rates for each operative procedure. There was no difference in survival between patients with or without bile duct resection for lymph node metastasis. The 5-year survival rates of pHinf-negative patients with stage 1B or more advanced disease after gallbladder bed resection or bisegmentectomy 4a,5 versus those without liver resection were 66% and 0%, respectively. Twelve patients survived for more than 5 years after surgery, including one patient undergoing HPD (liver resection with pancreatoduodenectomy) with positive lymph node metastasis; none was pBinf-positive. Several factyors were identified as having prognostic significance for survival in patients with gallbladder carcinomas, and we suggest that radical surgery may be indicated for selected patients with advanced disease.

High-level Skp2 Expression in Pancreatic Ductal Adenocarcinoma

Recent studies have shown that overexpression of S-phase kinase-associated protein 2 (Skp2) occurs in many cancers at an advanced stage. We examined the clinicopathologic significance and prognostic implication of Skp2 expression in pancreatic invasive ductal carcinoma. Tissue samples from 46 pancreatic carcinomas were examined immunohistochemically for Skp2. The proportion of constituent tumor cells with Skp2 expression was analyzed and classified as high-level nuclear expression when more than 20% of the cancer cells were positive, or low-level nuclear expression otherwise. High-level Skp2 overexpression was detected in 13 (28.3%) of the 46 tumors. The incidence of high-level Skp2 was correlated with higher histological grade (P = 0.0056), the extent of lymph node metastasis (P = 0.0086), the level of lymphatic permeation (P = 0.0024), and poorer patient outcome (P = 0.0189). Multivariate analysis showed that high-level Skp2 expression was an independent predictor of overall patient survival (P = 0.0140). It is suggested that examination of Skp2 expression might be clinically useful for prognostication in patients with pancreatic carcinoma and that Skp2 protein might be a novel therapeutic molecular target.

Value of Preoperative Ultrasonography in the Surgical Management of Initial and Reoperative Papillary Thyroid Cancer

Cervical recurrences, predominantly in lymph nodes, occur in 14% to 30% of patients with papillary thyroid cancer (PTC). Postoperative surveillance for recurrent PTC increasingly includes thyrotropin-stimulated thyroglobulin and high-resolution ultrasonography (US). This combination commonly can detect recurrent disease as small as 5 mm. Preoperative US will increase detection and assessment of the extent of lymph node metastasis (LNM) in patients with PTC. Retrospective cohort study. Tertiary care academic center. From January 1, 1999, to December 31, 2004, a total of 770 patients were seen, 551 (381 female and 170 male; median age, 47 years; age range, 9-89 years) who underwent initial surgical management and 219 (154 female and 65 male; median age, 44 years; age range, 5-90 years) who underwent cervical reoperation for PTC. The US images were obtained preoperatively for 486 initial and 216 reoperative patients. Therapeutic radioactive iodine was administered to 151 (68.9%) of the reoperative patients before the subsequent operation (median dose, 5.6 x 10(9) Bq; range, 7.4 x 10(8)-3.7 x 10(10) Bq). Ultrasonography identified nonpalpable lateral jugular LNMs in 70 (14.4%) of the patients undergoing initial exploration. Similarly, in reoperative patients, nonpalpable lateral LNMs were detected via US in 106 (64.2%), and 61 (28.2%) had LNMs detected in the central neck. Even when nodes were palpable preoperatively (37 [6.7%] of the initial and 56 [25.6%] of the reoperative patients), US assessment of the extent of LNM involvement altered the operation in 15 (40.5%) of the initial and 24 (42.9%) of the reoperative patients. The sensitivity, specificity, and positive predictive value for US were 83.5%, 97.7%, and 88.8% in initial patients, and 90.4%, 78.9%, and 93.9% in reoperative patients. Overall, preoperative US detected nonpalpable LNMs in 231 (32.9%) of the 702 patients with PTC who underwent US, thereby altering the operative procedure performed. In addition, even in patients with palpable LNs, US helped to guide the extent of lymphadenectomy.

Gene expression patterns in advanced human cervical cancer

The purpose of this study was to evaluate gene expression patterns in human cervical tumors by extent of lymph node metastases at diagnosis. Pretreatment whole-body fluorodeoxyglucose-positron emission tomography (FDG-PET) imaging was performed in eight patients with invasive squamous cell carcinoma of the cervix to evaluate the extent of lymph nodes metastases. Pretreatment tumor tissue samples were subjected to laser-capture microdissection, and isolated RNA was linearly amplified and hybridized to Affymetrix Human U95A GeneChip® microarrays. Molecular FDG-PET imaging revealed that three patients had lymph node involvement in the supraclavicular region and five patients did not. Microarray data were segregated into two groups based on the extent of regional lymph node involvement. Supervised clustering analysis identified 75 of about 12,000 gene transcripts represented on the array whose average expression was at least threefold different. We identified 12 of the 75 transcripts that demonstrated a statistically significant difference in expression between the two patient groups (P&lt; 0.05). Five transcripts were upregulated and seven downregulated. Both overall and cause-specific survivals were different between these two patient groups (P= 0.006). This limited data set identified candidate biomarkers of extent of lymph node metastases that correlated with poor survival outcome.

Gene expression patterns in advanced human cervical cancer

The purpose of this study was to evaluate gene expression patterns in human cervical tumors by extent of lymph node metastases at diagnosis. Pretreatment whole-body fluorodeoxyglucose-positron emission tomography (FDG-PET) imaging was performed in eight patients with invasive squamous cell carcinoma of the cervix to evaluate the extent of lymph nodes metastases. Pretreatment tumor tissue samples were subjected to laser-capture microdissection, and isolated RNA was linearly amplified and hybridized to Affymetrix Human U95A GeneChip microarrays. Molecular FDG-PET imaging revealed that three patients had lymph node involvement in the supraclavicular region and five patients did not. Microarray data were segregated into two groups based on the extent of regional lymph node involvement. Supervised clustering analysis identified 75 of about 12,000 gene transcripts represented on the array whose average expression was at least threefold different. We identified 12 of the 75 transcripts that demonstrated a statistically significant difference in expression between the two patient groups (P < 0.05). Five transcripts were upregulated and seven downregulated. Both overall and cause-specific survivals were different between these two patient groups (P= 0.006). This limited data set identified candidate biomarkers of extent of lymph node metastases that correlated with poor survival outcome.

Significance of the Number of Positive Lymph Nodes in Resected Non-small Cell Lung Cancer

In the current tumor, node, metastasis (TNM) classification of lung cancer, N status is defined by the anatomic extent of lymph node metastases. In this study, we evaluated the prognostic significance of the number of positive lymph nodes in resected non-small cell lung cancer. We retrospectively studied 289 patients with non-small cell lung cancer who underwent surgery, and we compared the prognostic significance of the number of positive nodes with the pN number by using multivariate analysis. Patients were classified into four groups according to the number of positive nodes: those without nodal metastasis were n, those with one to three positive nodes were n, those with four to six were n, and those with more than seven were n. The 5-year survival rate was 77% in the n patients, 58% in n, 42% in n, and 6% in n, which indicates that an increased number of positive lymph nodes was associated with poor prognosis. Among the pN2 patients, the n group had a better survival rate than the n and n groups. Multivariate analysis showed that the number of positive nodes was a significant prognostic factor, equal to the currently used pN number. Hazard ratios for pN1 and pN2 with respect to pN0 were 2.13 and 3.49; and 2.07, 3.03, and 10.4 for n, n, and n with respect to n. In addition, we found that our classification could reflect the better prognoses of skip or single-station nodal metastases. The number of positive lymph nodes is a strong independent prognostic factor in non-small cell lung cancer and may add new information to the pN categories of the current TNM classification.

Significance of Long-Term Follow-Up of Early Gastric Cancer

Therapeutic outcomes for most patients with early gastric cancer are favorable. However, mortality among these patients remains a concern. Improvements in therapeutic outcomes are being sought by studying the timing and causes of death. Here, the results of surgery were evaluated to assess the appropriate treatment and follow-up schedule for early gastric cancer. A total of 1169 patients with early gastric cancer underwent curative gastrectomy between 1992 and 1999. Survival time, prognostic factors, cause of death, and time of death were evaluated retrospectively. Multivariate analysis of disease-specific survival identified lymph node metastasis as an independent prognostic factor. The anatomical extent of lymph node metastasis and the number of metastatic lymph nodes influenced the rate of recurrence. Multivariate analysis of overall survival identified age as a prognostic factor. A total of 91 patients (7.8%) from the study group died: 56 from comorbid diseases, 21 from gastric cancer, and 14 from other second primary cancers. Death from gastric cancer was frequently observed within 5 years of surgical resection, whereas death from other diseases usually occurred after 5 years. Patients who died as a result of diseases other than gastric cancer tended to be older. Appropriate lymph node dissection is necessary for patients with early gastric cancer, particularly those with risk factors associated with lymph node metastasis. Meticulous follow-up protocols that can detect second primary cancers, together with the development of treatments for comorbid diseases, are required to improve survival.

膵管状腺癌におけるSkp2発現とリンパ節転移，組織学的異型度，予後不良との関連

膵管状腺癌におけるSkp2発現とリンパ節転移，組織学的異型度，予後不良との関連

Clinicopathologic Characteristics of and Prognosis for Patients with a Borrmann Type IV Gastric Carcinoma

Purpose: The prognosis for patients with a Borrmann type IV gastric cancer is extremely poor despite an aggressive surgical approach. We evaluated the clinicopathological features for Borrmann type IV cancers to find treatment strategy. Materials and Methods: The 1098 patients with advanced gastric cancer who underwent surgical resection between 1990 and 2001 were analyzed. These patients were divided into two groups: 81 patients with a Borrmann type IV carcinoma, and 1017 patients with all other types of gastric carcinomas. Results: Patients with a Borrmann type IV carcinoma were younger than those with other types, and female was prevalent (p=0.000). Of the patients with a Borrmann type IV gastric carcinoma, 68 patients (84%) were classified as stage III or IV at the initial diagnosis. The histologic type was commonly undifferentiated and serosal infiltration; nodal involvement and lymphatic invasion were more frequent in patients with a Borrmann type IV than in those with other types of cancer. Multivariate analysis confirmed that the extent of lymph node metastasis was a negative prognostic factor for Borrmann type IV gastric carcinomas. The curability for a Borrmann type IV carcinoma was only 53.1%, and peritoneal dissemination rate was 25.9%. The predominant pattern of recurrence for a Borrmann type IV gastric carcinoma was peritoneal dissemination, and it was significantly different with other types (93.1% vs 55.8%, P

Non-ominous micrometastases of gastric cancer

So-called R2 or wider meticulous node dissection was performed in 1368 patients with resected gastric cancer invading beyond the submucosa but without distant metastases. Survival rates were similar in subsets of patients with or without microscopic node metastases and macroscopically normal lymph nodes. The extent of node metastases has previously been shown to be one of the two most important prognostic factors in gastric cancer without distant metastases, and its lack of impact in these patient groups was not explained by the imbalance of other prognostic factors. The findings indicate that micrometastases of gastric cancer are curable by a wide node dissection made in the absence of palpable abnormality. They also offer the possibility that an extensive node dissection may yield good stage-specific survival rates, in part because of upstaging of patients. The findings should influence the recording of node metastases for evaluation of stage-specific treatment results and for research purposes.

Molecular pathological subclassification of mucinous adenocarcinoma of the colorectum

The purpose of the present report was to examine the possibility of molecular pathological subtyping of mucinous adenocarcinomas (MAC) of the colorectum. Thirty-five formalin-fixed and paraffin-embedded MAC specimens of the colorectum were analyzed. Genetic alterations of p53 gene and microsatellite instability (MSI) as well as immunohistochemical analysis of mucin subtypes (human gastric mucin (HGM), anti-mucin monoclonal antibody recognizing gastric gland mucous cells-1, MUC2, CD10) and expression levels of human mutL homolog 1 (hMLH1), p53 and Ki-67 were performed. According to MSI and p53 status, these tumors were subclassified into three groups: mutator-type tumors with a high frequency of MSI (20%), suppressor/p53-type tumors with p53 mutation, p53 overexpression or loss of heterozygosity of D17S250 (an adjacent locus to p53; 40%) and the unclassified tumors (40%). The suppressor/p53-type tumors had a significant association with distal colon location (P = 0.019), venous invasion (P = 0.002), extent of lymph node metastasis (P = 0.007) and higher tumor stage (P = 0.018). In contrast, mutator-type tumors had frequent expression of HGM (P = 0.005) and prominent lymphocytic infiltration at the advancing front of the tumor (P = 0.005). These results indicate that MAC of the colorectum could be subclassified according to molecular pathological background, reflecting distinct clinicopathological and phenotypic characteristics.

Long- term results after radical resection in patients with rectal cancer

To analyze the long- term results of radical resection for rectal cancer and the factors influencing the operative results. From January 1990 to December 1999, clinical data of 689 patients who underwent radical resection for rectal cancer were analyzed retrospectively. The overall operative mortality was 0.7%, the follow- up rate was 96.7%, the median survival rate was 67.4 months. The 1-, 3-, 5- and 10-year survival rate after operation was 89.9%, 77.3%, 69.6% and 63.3% respectively. Univariate analysis showed that the survival rate was related with the first onset symptom, tumor location, infiltrated circumference of intestine, T staging, Dukes staging, histological type, extent of lymph node metastasis and operative approaches. Multivariate analysis showed that tumor location, histological type, invasive depth and Dukes staging were independent prognostic factors. The long-term efficacy after radical resection for rectal cancer is correlated with tumor location, histological type, invasive depth and Dukes staging.