Prognostic Value of Tumor Biological Attitude and Host Response in Regional Lymph Nodes in Dukes' C Rectal Cancer

Hideki Ueno, Hidetaka Mochizuki, Kazuo Hase*, Toshihiko Yagyuu, Kazuyoshi Yoshimura, Sachio Yokoyama, Tetsuhisa Yamamoto, Shoetsu Tamakuma

First Department of Surgery of National Defense Medical College
*Department of Surgery of Self Defense Forces Central Hospital

Eighty patients who underwent curative resection of rectal carcinoma were studied to determine the prognostic value of tumor biological attitude in metastasized lymph nodes (LN) and the host response in non-involved LN. Patients with budding (bd) and/or extracapsular spread (ext-cap) in metastasized LN (AT(+)) showed a worse survival curve than patients without bd or ext-cap (AT(-)) (p<0.001). AT(+) patients had higher overall and local recurrence rates than AT(-) patients (p<0.001, p<0.01, respectively). The patients with two or three high grade responses of paracortical hyperplasia, germinal center hyperplasia, and sinus histiocytosis in non-involved LN (NA(+)) showed better survival curves than those with only one high grade response or none (NA(-)) (p<0.05). The patients with larger non-involved LN also showed a better survival curve than those with smaller ones (p<0.01). NA(+) patients showed a significantly lower incidence of AT(+) than NA(-) patients (p<0.05). It was indicated that bd and ext-cap in metastasized LN represented a vigorous biological attitude of the tumor and that the response in non-involved LN represented the host response to the tumor. Therefore, both tumor biological attitude in metastasized LN and host response in non-involved LN were thought to have prognostic value for rectal cancer.

Key words
lymph node metastasis of rectal cancer, extracapsular invasion in lymph node, tumor budding in lymph node, host response in lymph node

Reprint requests
Hideki Ueno First Department of Surgery, National Defense Medical College
3-2 Namiki, Tokorozawa, 359 JAPAN

Accepted
January 11, 1995

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