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Japanese Journal of Clinical Oncology 30:504-509 (2000)
© 2000 Foundation for Promotion of Cancer Research

Small Advanced Colorectal Cancers: Clinicopathological Characteristics and Pathogenetic Origin

Soichiro Ishihara1, Toshiaki Watanabe1, Naoyuki Umetani1, Seiichi Yamagata1, Tadahiko Masaki2, Hirokazu Nagawa1 and Tetsuichiro Muto3,+

1Department of Surgery, Division of Surgical Oncology, The University of Tokyo School of Medicine, Tokyo, 2Department of Surgery, Kyorin University School of Medicine, Mitaka and 3Cancer Institute Hospital, Tokyo, Japan

Background: Recently, increasing numbers of small but deeply invading colorectal cancers have been detected. We conducted the present study to examine the hypothesis that these small advanced cancers are more biologically malignant than larger cancers and to elucidate their pathogenetic origin.

Methods: We analyzed the clinicopathological characteristics of 23 advanced cancers not exceeding 2 cm in diameter (Small-Ca) in comparison with 1117 advanced cancers larger than 2 cm (Large-Ca). We compared the frequency of K-ras mutation and the growth pattern (polypoid growth, PG; non-polypoid growth, NPG) between Small-Ca and 60 submucosal cancers not exceeding 2 cm in diameter (Early-Ca).

Results: Generally, Small-Ca showed less malignant characteristics than Large-Ca. However, Small-Ca with NPG pattern invaded more deeply and metastasized more frequently than those with PG pattern. In Small-Ca, all ulcerated lesions showed NPG pattern, whereas only 14% of protruded lesions did. In Early-Ca, 90% of non-polypoid lesions showed NPG pattern, whereas only 16% of polypoid lesions did. K-ras mutation was less frequent in ulcerated Small-Ca than in polypoid cancers (33 vs 57%). In Early-Ca, non-polypoid cancers showed a lower frequency of K-ras mutation than polypoid cancers (9% vs 46%).

Conclusions: Small-Ca, in general, were less malignant clinicopathologically than Large-Ca; however, Small-Ca with NPG pattern showed a tendency to be more aggressive than those with PG pattern. The similarity of the K-ras mutation rate and growth pattern of ulcerated Small-Ca and non-polypoid Early-Ca suggests that the majority of ulcerated Small-Ca may originate from non-polypoid Early-Ca.

+ For reprints and all correspondence: Soichiro Ishihara, Department of Surgery, Division of Surgical Oncology, The University of Tokyo School of Medicine, 7–3–1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. E-mail: ishihara-1su@h.u-tokyo.ac.jp


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