Endoscopic features of early colorectal carcinomas smaller than 2cm: a retrospective study of 191 cases / 中国肿瘤临床

Objective: To examine endoscopic features of early colorectal carcinomas smaller than 2 cm. Methods: A total of 191 pa-tients (201 early colorectal carcinomas) who were definitely diagnosed with early colorectal cancer smaller than 2 cm between Janu-ary 2014 and December 2017 in Beijing Shijitan Hospital, Capital Medical University were enrolled. The patients'clinical characteris-tics, endoscopic and pathological data were retrospectively analyzed. Results: There were more male patients than female patients (1.81:1) in the study population; distribution of lesions was higher in the left colon than in the right colon (141/201). Group 1 had a higher number of IIa lesions (20/67, P=0.037) and a lower number of Ip lesions than Group 2 (52/134, P<0.01). Conclusions: There are special characteristics in distribution and endoscopic manifestations of early colorectal carcinoma. Lesion size was less than 1 cm in 67 (191 cases of early colorectal cancer) early colorectal carcinoma cases; however, a high-risk adenoma is defined as a lesion larger than 1 cm in size. Therefore, regardless of lesion size, if fractionation, echinodermata, congestion, erosion, expansion, and depression are observed, the lesion should be assessed in detail for the sake of carcinogenesis.

Risk factors for lymph node metastasis of early colorectal cancer and indices of endoscopic resection / 中华消化内镜杂志

Objective To analyse the risk factors for lymph node metastasis of early colorectal cancer and the therapeutic indication for endoscopy.Methods The clinical data of the 269 early colorectal cancer patients who underwent surgical treatments between January 2009 and December 2013 in the West China hospital of Sichuan University were analyzed retrospectively.Pathologic features were compared between different histological types and investigated by univariate and multivariate analysis of their possible risk factors for lymph node metastasis.Results Univariate analysis showed that tumor size (P =0.029),depth of tumor invasion (P =0.006),histological type (P =0.000) and lymphatic involvement (P =0.035) were correlated with lymph node metastasis.Multivariate analysis revealed that tumor size (OR =5.385,95％ CI:1.156-25.075,P =0.032)and histological type (OR =5.145,95％ CI:1.553-17.053,P =0.007) were independent risk factorsfor lymph node metastasis.Comprehensive analysis showed that lymph node metastasis could not be found in patients with tumor invading the mucous layer.However,lymph node metastasis occurred if the tumor invaded the submucous layer.The larger and less differentiated tumor was,the higher occurrence of lymph node matastasis would be (P ＜ 0.05).Conclusion Endoscopic resection is recommended for those with early colorectal cancer localized in the mucous layer and without lymph node metastasis.It is recommended that patients with submucosal carcinomas undergo a preoperative endoscopic ultrasonography or pathological screening for the most appropriate surgical treatment,as the larger and the lower differentiated the tumor is,the higher chance the lymphatic metastasis is.

Clinical Implications of Microsatellite Instability in T1 Colorectal Cancer

PURPOSE: The estimation of regional lymph node metastasis (LNM) risk in T1 colorectal cancer is based on histologic examination and imaging of the primary tumor. High-frequency microsatellite instability (MSI-H) is likely to decrease the possibility of metastasis to either regional lymph nodes or distant organs in colorectal cancers. This study evaluated the clinical implications of MSI in T1 colorectal cancer with emphasis on the usefulness of MSI as a predictive factor for regional LNM. MATERIALS AND METHODS: A total of 133 patients who underwent radical resection for T1 colorectal cancer were included. Genomic DNA was extracted from normal and tumor tissues and amplified by polymerase chain reaction (PCR). Five microsatellite markers, BAT-25, BAT-26, D2S123, D5S346, and D17S250, were used. MSI and clinicopathological parameters were evaluated as potential predictors of LNM using univariate and multivariate analyses. RESULTS: Among 133 T1 colorectal cancer patients, MSI-H, low-frequency microsatellite instability (MSI-L), and microsatellite stable (MSS) colorectal cancers accounted for 7.5%, 6%, and 86.5%, respectively. MSI-H tumors showed a female predominance, a proximal location and more retrieved lymph nodes. Twenty-two patients (16.5%) had regional LNM. Lymphovascular invasion and depth of invasion were significantly associated with LNM. There was no LNM in 10 MSI-H patients; however, MSI status was not significantly correlated with LNM. Disease-free survival did not differ between patients with MSI-H and those with MSI-L/MSS. CONCLUSION: MSI status could serve as a negative predictive factor in estimating LNM in T1 colorectal cancer, given that LNM was not detected in MSI-H patients. However, validation of our result in a different cohort is necessary.

Follow-up Results of Endoscopic Mucosal Resection for Early Colorectal Cancer / 대한소화기학회지

BACKGROUND/AIMS: Recently colonoscopy and screening programs have led to the detection and removal of increasing numbers of early colorectal cancer (ECC), which can reduce its related mortality. We analysed the clinical, endoscopic, and histologic findings, as well as the follow-up data, to evaluate the effectiveness and the long-term results of endoscopic mucosal resection (EMR) for ECC. METHODS: We analysed, retrospectively, 94 lesions in 92 patients who underwent EMR for ECC from January 2002 to June 2009. RESULTS: The overage age of patients was 60 years old. The mean follow-up period was 22.1 months (6-80). En bloc resection rate was 64.9%. Submucosal invasion was found in 30 cases (31.9%). De novo cancer rate was 26.6% which had higher submucosal invasion rate (60%, p=0.003). The complete resection rate was 87.2%, and there was no recurrence of cancer during follow-up (p=0.000). Twelve incomplete resection cases had received further surgical treatments. No procedure-related mortality was found and no recurrent malignancy was found except 1 case. CONCLUSIONS: This study shows that EMR is an effective and safe treatment for ECC. En bloc resection provides precise histologic information and prevention of tumor recurrence.

Follow-up Results of Endoscopic Mucosal Resection for Early Colorectal Cancer / 대한소화기학회지

BACKGROUND/AIMS: Recently colonoscopy and screening programs have led to the detection and removal of increasing numbers of early colorectal cancer (ECC), which can reduce its related mortality. We analysed the clinical, endoscopic, and histologic findings, as well as the follow-up data, to evaluate the effectiveness and the long-term results of endoscopic mucosal resection (EMR) for ECC. METHODS: We analysed, retrospectively, 94 lesions in 92 patients who underwent EMR for ECC from January 2002 to June 2009. RESULTS: The overage age of patients was 60 years old. The mean follow-up period was 22.1 months (6-80). En bloc resection rate was 64.9%. Submucosal invasion was found in 30 cases (31.9%). De novo cancer rate was 26.6% which had higher submucosal invasion rate (60%, p=0.003). The complete resection rate was 87.2%, and there was no recurrence of cancer during follow-up (p=0.000). Twelve incomplete resection cases had received further surgical treatments. No procedure-related mortality was found and no recurrent malignancy was found except 1 case. CONCLUSIONS: This study shows that EMR is an effective and safe treatment for ECC. En bloc resection provides precise histologic information and prevention of tumor recurrence.

Minute-depressed Type of Submucosal Colon Cancer / 대한소화기내시경학회지

The development of colorectal cancer has been known as the adenoma-carcinoma sequence. Yet another route for cancer development has recently been proposed, which is call the de novo pathway based on the reports of the depressed-type early colorectal cancers. Early colorectal cancer is defined as invasive tumor limited to the colorectal mucosa or submucosa, regardless of the presence or absence of lymph node metastasis. Especially, depressed type colorectal cancers have a much higher rate of submucosal invasion and rapid progression despite of their relatively small sizes. Our case displayed a depressed type tumor that was only 5mm in diameter and it had invaded the deep submucosal layer (SM3); this was resected by operation with no predictive endoscopic finding. So, the depressed type tumor can show deep invasion or lymph node metastasis despite of its small size.

Depressed-Type of Early Colon Cancer with Extensive Lymph Node Metastasis

Early colorectal cancer (ECC) is defined as invasive tumor limited to the colonic and rectal mucosa or submucosa, regardless of the presence or absence of lymph node metastasis. The incidence of lymph node metastasis in ECC ranges from 0 to 15.4%, and risk factors include depth of submucosal invasion, growth patterns (polypoid or non-polypoid), histologic subclassification, and lymphatic invasion. Of non-polypoid growth patterns, the depressed types of colorectal cancer have higher malignant potential than polypoid types, even for small sizes. Unfortunately, this type is also difficult to detect on colonoscopic examination. In this report, we describe a case of depressed type ECC with extensive lymph node metastasis without regional lymph node involvement.

Follow-up Results of Endoscopic Mucosal Resection for Early Colorectal Cancer

PURPOSE: Endoscopic mucosal resection (EMR) for early colorectal cancer (ECC) is increasing, but in Korea, little is known about long-term results of this treatment, especially in cases of incomplete resection. In this study, we reviewed the records of patients with ECC who underwent EMR, and we analysed the clinical, endoscopic, and histologic findings, as well as the follow-up data, to evaluate the effectiveness and the long-term results of EMR. METHODS: From May 1995 to December 2003, 45 patients underwent EMR for ECC at Seoul National University Hospital and followed for over 10 months. Their medical records were reviewed retrospectively. RESULTS: 45 patients with average age of 62 accounted for 47 ECCs out of 164 colon mucosal lesions. En-bloc resection rate was 78.7%. Submucosal invasion was found in 10 cases (21.3%). De novo cancer rate was 12.8% and relatively high in submucosal cancer (40%). The complete resection rate was 70.2%. During the mean follow-up period of 25 months, residual tumor growth occurred in 3 out of 14 incompletely resected cases, and that was related to piecemeal resection. One of those 3 patients underwent surgical resection due to submucosal invasion, and the other two were treated endoscopically with no additional abnormal findings. No tumor recurred in completely resected cases. CONCLUSIONS: A complete en-bloc resection was a prerequisite for prevention of tumor recurrence. In cases of incomplete resection, especially those performed using piecemeal method, within 3 months after the resection and within 1 year thereafter, follow-ups are essential for the early detection of tumor regrowth, and additional endoscopic treatment can achieve complete removal of residual tumor, despite initial incomplete resection.

Local Resection for Treatment of Early Colorectal Cancer

PURPOSE: Early colorectal cancer is defined as invasive tumor, limited to the mucosa or submucosa. The incidence of early colorectal cancer detection has been increased due to well designed screening technology and development of colonoscopy. The novel treatment of early colorectal cancer is still not settled despite of this advancement. We performed retrospective study about outcomes of colorectal cancer after radical resection or local resection. METHODS: Sixty two patients, diagnosed as early colorectal cancers by pathology, were selected for this case study. The hospital records were reviewed retrospectively and the following was found: Twenty four patients received local resection such as colonoscopic polypectomy or local resection of colon. Remaining thirty-eight patients received radical resection. The clinicopathologic features of two groups were analyzed statically and survival rate was compared. RESULTS: The clinical features were similar between two groups including sex, age, stage, tumor size and differentiation. The median follow-up duration was 47.3 months (range: 2~152 months). Survival rate was not different according to resection type. Recurrent cases were one patient from each group. They were all submucosal tumors. CONCLUSIONS: The local resection is safe treatment modality for early colorectal cancer. However, case selection for local resection should be cautious because submucosal cases have more recurrent potential. Longterm follow-up will be needed to achieve safety of early colorectal cancer.

Clinical Significance of Depressed-Type Colorectal Neoplasms Based on Growth and Development

A route of colorectal cancer development other than the adenoma-carcinoma sequence has recently become an issue due to the discovery of depressed-type early colorectal cancers. Moreover, the fact that some polyp-like cancers actually originate from depressed-type lesions has become obvious. Despite the protruding shapes of depressed-type early colorectal cancers, they probably have biological characteristics, which are different from those of the usual polyp lesions. We undertook this study to evaluate the clinical significance of depressed-type colorectal neoplasms. The authors recently experienced 87 cases of depressed-type colorectal neoplasms. Using Kudo's classification, we classified these 87 cases into three types based on their growth patterns, type IIc, type IIa + IIc, and type Is + IIc, and then analyzed these types on the basis of size, type, and submucosal invasion rate. The submucosal invasion rate of cancers of type IIa + IIc was significantly higher than that of type IIc (p < 0.05), and the rate for cancers of types IIa + IIc and Is + IIc together was significantly higher than that of type IIc (p < 0.05). However, no significant difference was found between the rates of types IIa + IIc and Is + IIc. In conclusion, the IIa + IIc and Is + IIc sub-types of depressed-type colorectal neoplasms, individually and together, have higher rates of submucosal invasion than type IIc lesions. Accordingly, type IIa + IIc and type Is + IIc must be differentiated from the usual polyps and should be managed cautiously, despite their protruding shapes.

The diagnostic value with analysis of pit pattern classificaion on early cancer of large intestine detection / 中华消化杂志

Objective To evaluate diagnostic value of pit pattern analysis on detection of early colorectal carcinoma. Methods 4176 patients were examined with colonoscopy and had the mucosal lesions stained with 0.4% indigo carmine, and part of them observed with magnifying endoscope and stereomicroscope, then compared the mucosal crypt patterns (the pit patterns Kudo classification) with pathologic diagnosis. Results There were 955 protruded and flat lesions on the large intestine mucosa in 752 patients, and among them there are 14 early cancers, 209 advanced cancers, 76Ⅱa、Ⅱb、Ⅱc、Ⅱa+Ⅱc lesions. We also found 43 laterally spreading tumors (LST) ranging from 16 to 110 mm in diameter, 2 for pit Ⅱ,18 for pit Ⅲ L, 19 for pit Ⅳ, 1 for pit Ⅴ A, 1 for Ⅴ N. The pit pattern of the most non neoplastic lesions was type Ⅰ or Ⅱ, which is about 85.4% (303/355), and the type of the adenomas was type Ⅲ or Ⅳ, about 86.0% (504/586). All the invasive carcinomas'pit patterns were type Ⅴ and there were 8 for type Ⅴ (2 Ⅴ A, 6Ⅴ N) among 14 early carcinomas. Conclusion Pit pattern analysis is a very important tool to determine the nature of lesions, which helps to decide the kinds of later therapeutic intervention.

Significance of Subclassification of Depressed-Type Early Colorectal Cancer Based on Growth and Development

PURPOSE:Recently it became obvious that some early cancers which appeared to be polyp lesions had actually originated from depressed-type lesions. The aim of this study was to clarify both the characteristics of depressed- type early colorectal cancers compared with protruded- or flat-type ones and the significance of a subclassification of depressed-type early cancers. METHODS:The authors experienced 248 early colorectal cancers from 1996 to 2000. We classified those cancers into protruded, flat, and depressed types based on growth and development. Further, we used Kudo's classification to subclassify the depressed-type cancers into three sub-types, IIc, IIa+IIc, and Is+IIc. We analyzed the 248 cases with emphasis on size, type, sub-type, and submucosal cancer (sm) rate. RESULTS:The sm rate of the depressed cancers was 81.8% (18/22) and was significantly higher than those of the protruded (30.5%) or the flat (38.5%) types (P<0.05). The sm rate of the depressed lesions not larger than 10 mm was 70% (7/10) and that of the lesions from 11 mm to 20 mm was 91.7% (11/12); there were no depressed cancers larger than 20 mm in diameter. The sm rate of the type IIa+IIc plus type Is+IIc lesions was higher than that of type IIc lesions (93.3%, 14/15 vs. 57.1%, 4/7). Endoscopic resection was done in 74.2% of all early colorectal cancers. CONCLUSIONS:The sm rate of depressed-type early colorectal cancers was 82%, and no depressed cancers were larger than 20 mm in diameter, suggesting that by the time a depressed-type cancers had become larger than 20 mm in size, it had already progressed into an advanced cancer. Thus, it is very important to detect depressed-type cancers in an early stage. Moreover, it is imperative to differentiate type IIa+IIc and type Is+IIc from polyp lesions and to manage them cautiously because their sm rate is higher than that for type IIc lesions.

Risk Factors of Lymph Node Metastasis in Submucosally Invasive Colorectal Carcinoma: with Special Reference to the Depth of Invasion / 대한소화기내시경학회지

BACKGROUND/AIMS: It has been reported that lymph node (LN) metastasis occurs in approximately 10 percent of patients with submucosally invasive colorectal carcinoma. The present study was performed to determine the clinical significance of absolute and relative depth of submucosal invasion and to find the associated pathological risk factors of LN metastasis in submucosally invasive colorectal carcinoma. METHODS: From June, 1989 to May, 1999, 2,580 patients were pathologically confirmed as having colorectal carcinoma. Of these patients, a total of 61 subjects with submucosally invasive carcinoma could be reviewed pathologically and were included in this retrospective analysis. The relative depth of submucosal invasion was evaluated by Kudo (sm1, 2, 3) and modified Haggitt (L1, 2, 3) classifications, and the absolute depth was measured. RESULTS: The absolute depth of submucosal invasion was significantly correlated with the relative depth evaluated by both Kudo and modified Haggitt classifications (p<0.01). Of 51 patients in whom the status of LN metastasis could be evaluated, six (11.8%) showed LN metastasis. Among the patients with LN metastasis, there was no one with sm1 or L1 in the relative depth and 500 micrometer or less in the absolute depth. The risk of LN metastasis was related to the gross type, and lymphatic or vessel invasion (p<0.05). CONCLUSIONS: The risk factors for LN metastasis in submucosally invasive colorectal carcinoma were the gross type and lymphatic or vessel invasion. The results also suggest that the absolute depth of submucosal invasion might be a useful parameter to select the patients for the endoscopic treatment.

Macroscopic Classification and Histo-Pathologic Evaluation of Early Colorectal Cancer with Elevated Type / 대한소화기내시경학회지

BACKGROUNDS/AIMS: Early colorectal cancer is defined as carcinoma with invasion to mucosa or submucosa irrespective of involvement of lymph node. Gross morphology is divided into elevated and depressed type according to growth pattern. Until now, carcinomas with elevated type have been found more frequently than depressed type in Korea. It is necessary to classify the macroscopy of morphology and evaluate histo-pathologic findings of early colorectal cancers. METHODS: 33 patients (35 foci) with early colorectal cancers were analyzed, macroscopically and pathologically. Early colorectal carcinoma with mucosal invasion is 25 cases, and with submucosal invasion, 10. RESULTS: Macroscopic classification: Ip 12, Isp 6, Is 9, IIa 1, IIa IIc 4, Isp IIc 1, LST 2. Among them, Ip (34%) is most. Among cancers with mucosal invasion, Ip (36%) is common, and with submucosal invasion, Is (40%) is common. Most of early colorectal cancers with elevated type were accompanied with surrounding adenoma. It's ratio is 100% in early colorectal cancer with mucosal invasion, and 50% with submucosal invasion. CONCLUSIONS: Pedunculated type (Ip) is common in early colorectal cancer with elevated type. Surrounding adenoma was usually (85%) accompanied with those. It is suggested that early colorectal cancer with elevated type would be originated from adenoma.

Endoscopic Mucosal Resection and Its Clinical

PURPOSE: Endoscopic mucosal resection (EMR) or endoscopic piecemeal mucosal resection (EPMR) is a useful method for treating benign neoplastic lesions and selected cases of early colorectal cancers, especially those cancers with flat or depressed shapes. However, clinical data concerning EMR or EPMR are still lacking. Accordingly, we designed this study to review and analyze our cases for more information and in order to achieve more adequate and prudential application. METHODS: We performed 2609 colonoscopic polypectomies from January 1997 to December 1998. Among those, 77 lesions (3.0%) were treated by using the EMR or the EPMR technique. We analyzed those 77 lesions with special reference to size, configuration, and histologic diagnosis. RESULTS: The most common age group was the 5th decade. The male-to-female ratio was 1.75:1. The most common sites of the lesions were the rectum and the sigmoid colon. Most of the lesions were equal to or smaller than 15 mm in size (97.4%). Flat, elevated lesions were the most common type (39%), followed by sessile (31.2%) and depressed (18.2%) lesions in order. Adenomas and adenocarcinomas accounted for 51.9% (40/77) of the lesions and the malignancy rate was 9.1% (7/77). Three were submucosal cancers. Seventy-one percent of the carcinomas were less than 10 mm in size, and the only submucosal cancer was below 5 mm in size and was a depressed lesion. Carcinoid tumors accounted for 15.6% of the lesions, and chronic nonspecific inflammation for 9.1%. An EPMR was performed on 4 lesions which were larger than 10 mm. There were no complications such as bleeding, perforation, or recurrence. CONCLUSIONS: EMR and EPMR are useful endoscopic resection techniques, especially for sessile, flat, and depressed neoplastic lesions. Lesions up to 15~20 mm in size are good candidates for EMR and those up to 40 mm for EPMR. At the same time, a carefully performed procedure is mandatory to prevent recurrence or complications such as bleeding or perforation.

Endoscopic Diagnosis and Treatment of Early Colorectal Cancer

PURPOSE: Detecting and treating early colorectal cancers are most important for preventing advanced colorectal cancers which are difficult to manage. However, there is still a lack of data and guidelines in Korea about early colorectal cancers, especially when endoscopy is concerned. This study was undertaken in an effort to gather information in this area. METHODS: We experienced 107 early colorectal cancers from 1995 to 1998. We analyzed them with special reference to endoscopic characteristics and treatment. Ninty-six cases were followed for an average of 17 months. RESULTS: Ninty-four (87.9%) of the early colorectal cancers were detected during the last two years of the study. The male-to-female ratio was 2.1 to 1. The most common age group was the 7th decade. The rectum and the sigmoid colon were involved in 85% of the early cancers. Lesions smaller than 20 mm accounted for 54.2% of the early cancers and ones smaller than 10 mm 15%. There were no malignancies in flat-elevated lesions smaller than 10 mm; to the contrary, there was a 66.7% malignancy rate in depressed lesions. Malignancy developed in LSTs (Laterally spreading tumors) larger than 20 mm. Regarding configuration, protruded-type tumors accounted for 80.4% of the lesions, depressed-type tumors 5.6%, and LSTs 4.7%. The most common endoscopic characteristic of early colorectal cancer was redness. White spots, hardness, easy bleeding upon touch, and nodules were recognized in more than 20% of the tumors; depression and erosion were noticed in more than 10%. An expanded figure, convergence of mucosal folds, a whitish patch, and ulceration were useful in some cases. The submucosal cancer rate was 30.2% in protruded-type lesions and 66.7% in depressed-type ones. The overall adenoma-association rate was 93%. All lesions without an adenomatous component were submucosal cancers. The overall endoscopic resection rate was 87.9%. Among them, those who needed additional surgical resection accounted for 13.8% (13/94). Three recurrences were recognized. Those three were all early rectal cancers associated with villous tumors and were larger than 20 mm. All recurrences were treated endoscopically. There was one case of bleeding within 1 day after endoscopic resection. That was associated with a 20-mm, pedunculated lesion in the ascending colon and was treated using a detachable snare. CONCLUSIONS: It is important to recognize the endoscopic characteristics of early colorectal cancers, especially those of depressed lesions and LSTs. Those characteristics are also useful in selecting appropriate candidates for endoscopic resection.

Depressed-Type Early Colorectal Cancer / 대한소화기내시경학회지

BACKGROUND AND AIM: While detection and removal of polyps on the basis of the adenoma-carcinoma sequence has been a principal procedure for endoscopists, a new type of early colorectal cancer has been recognized and has become a hot issue. This new ailment is a depressed-type early colorectal cancer, which has the characteristics of rapid growth and early invasion of the submucosa. Though once considered to be mere conjecture, many researchers claim that this cancer is a de novo carcinoma despite of its rare occurrence. Recently, 4 depressed-type neoplastic lesions were presented, which signifies the importance of recognizing that this type of cancer exists and is characterized by rapid growth and early invasion of the submucosa. METHODS: The 4 recently experienced depressed neoplastic lesions were reviewed and analyzed with respect to their endoscopic and clinicopathologic characteristics. The sizes of the lesions were measured in the fully inflated state of the bowel by using an endoscopic ruler. RESULTS: The sites of predilection were the descending and sigmoid colon. All of the lesions were under 10 mm, with 75% being below 5 mm. The largest lesion was an 8-mm, well-differentiated mucosal carcinoma. The overall malignancy rate was 25%. Light redness was observed in all patients. Distortion with air transformation of the mucosal fold was also recognized in all the patients. The main treatment was endoscopic mucosal resection, which amounted to 50%. CONCLUSIONS: Depressed colorectal neoplasms are real. They can be determined by their characteristic endoscopic features, such as light redness and distortion with air transformation of the mucosal fold. Because of their characteristics of rapid growth and early invasion of the submucosa, it is important to detect and manage them in an early stage, when their sizes are below 10 mm.

Early Colorectal Cancer

Purpose : Early colorectal cancer is defined as the depth of tumor invasion limited to mucosa or submucosa regardless of the presence or absence of lymph node metastasis. We performed a retrospective study to determine the chronological changes in frequencies of early colorectal cancer and clinicopathologic differences between early colorectal cancer (ECC) and advanced colorectal cancer (ACC). Methods : We reviewed hospital records of the patients with colorectal cancer operated between January 1990 and December 1995. We classified the patients into two groups, ECC and ACC, according to the depth of tumor invasion and compared the clinicopathologic characteristics. Results : Fifty eight patients (5.2%) were diagnosed with early colorectal cancer among 1113 colorectal cancer patients operated at the same period. The frequency of ECC has increased from 1.9% in 1970~1989 to 5.2% in 1990~1995. The average age of patients with ECC at the time of surgery was 55.8 compared to 56.5 for patients with ACC group (p>0.05). Most patients (72.4%) with ECC had bleeding symptoms and majority of the ECCs were located in the rectum (72.4%). The mean size of tumors was 2.6 cm in its greatest diameter and was significantly smaller than that of ACC (5.7 cm). Compared to ACC, ECC had better histologic differentiation and fewer lymph node metastases (p<0.05). Thirty six of the ECC patients underwent bowel resection and remaining 22 underwent local excision. After a mean follow up period of 39.1 months (range 2~81months), recurrence was detected in one case. There was no death during the follow up period. Conclusion : The frequency of ECC has increased recently. Compared to patients with ACC, patients with ECC had more favorable clinicopathologic characteristics and better outcome. In selected patients, minimal operation can be applied without compromising the clinical outcome.

Microvessel Count and Overexpression of p53 in Early Colorectal Cancer / 대한암학회지

PURPOSE: Angiogenesis, playing a critical role in tumor growth, development, and metastatic process, is alleged to be related to the prognostic factors and patient's survival of the colo-rectal cancer. The p53 gene, present in short arm of chromosome 17, is involved in multistep colo-rectal carcinogenesis. The correlation of p53 gene and angiogenesis has been recently reported. So, we designed to assess (1) the rate of p53 overexpression, (2) the prognostic significance of microvessel count, and (3) the relationship of p53 overexpression and angiogenesis in early colo-rectal cancer(ECC) patients. MATERIAL AND METHODS: The study material included 68 ECC from 65 patients, 40 mucosal (m-ECC) and 28 submucosal ECCs (sm-ECC). Immunostainings against p53 and factor VIII-related antigen were done and the results were analyzed with respect to tumor depth, site, and differentiation. And also the correlation between p53 overexpression and microvessel counts(MVC) was performed. RESULT: The rate of p53 overexpression was higher in sm-ECC than in m-ECC (p < 0.05). The rate of p53 overexpression was highest in sigmoid colon and statistically significantly different compared with other sites. The differentiation of the tumor was closely correlated with p53 overexpression and the poorer the differentiation, the more overexpression of p53 (p<0.05). There was no significant difference between MVCs of m-ECC and sm-ECC (27.2+/-5.5 and 29.8 +/-6.0,respectively). However, MVC were higher in sigmoid colon than in any other sites (p<0.05). MVC did not show significant correlation with tumor differentiation or p53 overexpression. CONCLUSION: These data indicate that p53 overexpression is correlated with tumor depth and differentiation but not MVC. The significance of higher MVC and p53 overexpression in sigmoid colon are reserved for further studies.