gnckКолопроктологияKoloproktologia2073-75562686-7303Russian Association of Coloproctology10.33878/2073-7556-2021-20-4-22-33gnck-1668Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESНовые морфологические факторы риска метастазирования в регионарные лимфоузлы при раке прямой кишки с инвазией в подслизистую основуNew morphological risk factors for metastasis to regional lymph nodes in rectal cancer with invasion into the submucosahttps://orcid.org/0000-0001-8189-3071МайновскаяО. А.MaynovskayaO. A.

Майновская Ольга Александровна

ул. Саляма Адиля, д. 2, Москва, 123423

Maynovskaya Olga А.

Salyama Adilya str., 2, Moscow, 123423

moalex_68@mail.ruhttps://orcid.org/0000-0002-3919-9067Рыбаков Е. Г.RybakovE. G.

ул. Саляма Адиля, д. 2, Москва, 123423

Rybakov Evgeny G.

Salyama Adilya str., 2, Moscow, 123423

https://orcid.org/0000-0002-6212-9454ЧернышовС. В.ChernyshovS. V.

ул. Саляма Адиля, д. 2, Москва, 123423

Chernyshov Stanislav V.

Salyama Adilya str., 2, Moscow, 123423

https://orcid.org/0000-0002-8480-9362Шелыгин Ю. А.ShelyginYu. A.

ул. Саляма Адиля, д. 2, Москва, 123423

Shelygin Yuri A.

Salyama Adilya str., 2, Moscow, 123423

https://orcid.org/0000-0001-9294-5447АчкасовС. И.AchkasovS. I.

ул. Саляма Адиля, д. 2, Москва, 123423

Achkasov Sergey I.

Salyama Adilya str., 2, Moscow, 123423

ФГБУ "НМИЦ колопроктологии имени А.Н.Рыжих" Минздрава РоссииРоссияRyzhikh National Medical Research Center of ColoproctologyRussian FederationФГБУ «НМИЦ колопроктологии имени А.Н. Рыжих» Минздрава РоссииRussian FederationRyzhikh National Medical Research Center of ColoproctologyRussian Federation2021211220212042233Copyright © Майновская О.А., Рыбаков  Е.Г., Чернышов С.В., Шелыгин  Ю.А., Ачкасов С.И., 20212021Майновская О.А., Рыбаков  Е.Г., Чернышов С.В., Шелыгин  Ю.А., Ачкасов С.И.Maynovskaya O.A., Rybakov E.G., Chernyshov S.V., Shelygin Y.A., Achkasov S.I.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.ruproctology.com/jour/article/view/1668ЦЕЛЬ

ЦЕЛЬ: изучить прогностическое значение основных и новых морфологических признаков КРР и их взаимосвязь с метастазами в регионарные лимфоузлы при раке прямой кишки рТ1.

МАТЕРИАЛЫ И МЕТОДЫ

МАТЕРИАЛЫ И МЕТОДЫ: материалом для исследования являлись препараты (n = 66) удаленной прямой кишки с верифицированной морфологически аденокарциномой. Было изучено прогностическое значение основных морфологических параметров: глубина инвазии опухоли в подслизистый слой, степень дифференцировки, лимфоваскулярная инвазия; а также феномен «почкования» опухоли, плохо дифференцированные кластеры и разрывы желез по инвазивному краю опухоли.

РЕЗУЛЬТАТЫ

РЕЗУЛЬТАТЫ: метастазы в параректальных лимфоузлах были обнаружены в 13 (19,7%) случаях. С высокой степенью достоверности метастазы в лимфоузлах мезоректума определялись при наличии лимфоваскулярной инвазии [ОШ 38,0 95%, ДИ 2, 1–670, р < 0,0001]. Опухолевый баддинг высокой степени (Bd3) достоверно чаще определялся при опухолях с метастазами в параректальные лимфоузлы [ОШ 6,2, ДИ 1,2–31, р < 0,0001]. Плоходифференцированные кластеры опухоли (PDС) достоверно ассоциировались с метастазами в мезоректальных лимфоузлах (р = 0,03). Такие морфологические признаки как глубина инвазии опухоли, степень ее дифференцировки, разрыв железистых структур опухоли не показали достоверной связи с метастазами в регионарные лимфоузлы. В модели логистической регрессии единственным независимым фактором риска метастазов в регионарные лимфоузлы являлась лимфоваскулярная инвазия (p < 0,0001).

ЗАКЛЮЧЕНИЕ

ЗАКЛЮЧЕНИЕ: Лимфоваскулярная инвазии, опухолевый баддинг и плоходифференцированные кластеры — наиболее значимые факторы риска метастазов в лимфоузлы при Т1 раке прямой кишки.

 

 

AIM to assess prognostic significance of pathologic features of T1 rectal carcinoma in relation to regional lymph nodes involvement (N+).

MATERIAL AND METHODS

MATERIAL AND METHODS: surgical specimens (n = 66) from rectal resection for carcinoma pT1 were investigated. Following prognosticators were evaluated: depth of submucosal invasion, grade of differentiation, lymphovascular invasion (LVI), tumor budding (Bd), poorly differentiated clusters (PDC) of tumor and rupture of cancer glands (CGR).

RESULTS

RESULTS: lymph nodes metastases were found in 13 (19.7%) specimens. LVI was associated lymphatic spread in great possibility OR 38.0 95% CI 2.1-670 (p < 0.0001). Tumor budding of high grade (Bd3) OR 6.2 95% CI 1.2-31 (p < 0.0001) and poorly differentiated clusters (p = 0,03) also increased risk of lymph node metastases. Depth of submucosal invasion, grade of differentiation, and rupture of cancer glands failed to demonstrate significant association with N+. Logistic regression analysis allowed to determine LVI as independent prognostic factor of lymph node tumor involvement.

CONCLUSION

CONCLUSION: lymphovascular invasion, tumor budding and poorly differentiated clusters of tumor are risk factors of T1 rectal carcinoma lymph node metastases.

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The authors declare that there are no conflicts of interest present.