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. 2011 Sep;59(3):470-81.
doi: 10.1111/j.1365-2559.2011.03964.x.

Histopathological predictors of regional lymph node metastasis at the invasive front in early colorectal cancer

Yuri Akishima-Fukasawa  1 , Yukio Ishikawa, Yoshikiyo Akasaka, Miwa Uzuki, Naomi Inomata, Tomoko Yokoo, Ryuga Ishii, Reiko Shimokawa, Kiyoshi Mukai, Hideko Kiguchi, Koyu Suzuki, Mieko Fujiwara, Kentaro Ogata, Hitoshi Niino, Hitoshi Sugiura, Akihiro Ichinose, Yoshikazu Kuroda, Daisuke Kuroda, Toshiharu Ishii
Affiliations

Histopathological predictors of regional lymph node metastasis at the invasive front in early colorectal cancer

Yuri Akishima-Fukasawa et al. Histopathology. 2011 Sep.

Abstract

Aims: In early colorectal cancer (ECC), prediction of lymph node (LN) metastasis is vital for the decision of additional surgical treatment after endoscopic mucosal/submucosal resection. The aim of this study was to determine the relationship between LN metastasis and comprehensive histopathological findings including the cancer microenvironment in ECC.

Methods and results: Using 111 ECC cases, including 36 cases with LN metastasis, histopathological observations and immunohistochemistry for lymphatic vessel endothelial hyaluronan receptor-1 (LYVE-1), von Willebrand factor, matrix metalloproteinase-7 (MMP-7), CXC chemokine ligand-12 (CXCL12) and angiopoietin-like-4 (ANGPTL4) were conducted. Relationships between LN metastasis and growth pattern, status of muscularis mucosae, depth of cancer invasion, overall histopathological type, histopathological type at the invasive front, tumour budding, neutrophil infiltration in cancer cells (NIC), fibrotic cancer-stroma type, Crohn's-like lymphoid reaction, microscopic abscess formation and lymphatic invasion were determined. In addition, the expression of MMP-7, CXCL12 and ANGPTL4 in cancer cells at the invasive front were also considered in the context of LN metastasis. By multivariate analysis, lymphatic invasion, NIC and MMP-7 expression at the invasive front were independent predictors of LN metastasis.

Conclusions: LN metastasis is regulated not only by the characteristics of cancer cells but also by microenvironmental factors of lymphatics and neutrophils, especially at the invasive front.

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