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目的回顾性研究结直肠癌的术前肠镜活检标本中能否发现黏膜下层浸润证据与肿瘤临床病理学以及肠镜取材特点间的关系。方法对第二军医大学附属长海医院2007年1月至2008年12月收治的结直肠癌病例相应的肠镜活检标本石蜡切片进行回顾性阅片,观察是否具有黏膜下层浸润证据,利用卡方检验、t检验以及logistic回归分析对肿瘤临床病理学特点与能否在活检标本中发现黏膜下层浸润证据的关系进行统计学分析。结果 321例结直肠癌病例中,共216例(67.3%)可以发现黏膜下层浸润,单因素分析显示活检组织块直径较小的病例(P=0.042)、黏液腺癌(P=0.003)、高级别肿瘤(P=0.001)、淋巴结阳性的病例(P=0.011)以及深层次浸润病变(P=0.092)中发现黏膜下层浸润证据的比例显著下降,多因素回归分析显示高级别肿瘤(OR2.155,95%CI1.081～4.296,P=0.029),以及活检组织直径较小的病例(OR1.944,95%CI1.149～3.290,P=0.013)与活检组织中无法确定黏膜下层浸润相关。结论对于临床上高度怀疑恶性的结直肠肿瘤,虽然肠镜活检标本中未发现黏膜下层浸润,不能简单的诊断为高级别上皮内瘤变,应怀疑为晚期或者恶性程度较高的病变。
Objective To retrospectively study the relationship between the evidence of submucosal invasion and the clinicopathological features of colon cancer and the features of colonoscopy collected from preoperative colonoscopy biopsy specimens of colorectal cancer. Methods Retrospective paraffin biopsy specimens from patients with colorectal cancer admitted to Changhai Hospital of the Second Military Medical University from January 2007 to December 2008 were retrospectively reviewed to see if there was evidence of submucosal invasion. , T test and logistic regression analysis were used to analyze the relationship between clinicopathological features and evidence of submucosal invasion found in biopsy specimens. Results A total of 216 cases (67.3%) of 321 cases of colorectal cancer were found to be infiltrating into the submucosa. Univariate analysis showed that the biopsies had smaller diameter (P = 0.042), mucinous adenocarcinoma (P = 0.003) (P = 0.001), lymph node positive cases (P = 0.011), and deep invasive lesions (P = 0.092). The multivariate regression analysis showed that the proportion of high grade tumors (OR2.155 , 95% CI1.081 ~ 4.296, P = 0.029), and the biopsies with smaller diameter (OR1.944,95% CI1.149 ~ 3.290, P = 0.013) were not associated with submucosal invasion in biopsies. Conclusions For colorectal tumors that are highly suspected to be clinically malignant, although there is no submucosal invasion found in the colon biopsy specimens, they can not be easily diagnosed as high grade intraepithelial neoplasia, and should be suspected to be advanced or malignant lesions.