关于带蒂T1结直肠癌（CRC）淋巴结转移（LNM）的预测存在争议。在这项研究中，有四例带蒂的T1CRC，我们旨在基于与Haggitt系(HL)的距离研究基因表达变异,并确定LNM的潜在分子危险因素.通过利用癌症转录组Atlas和数字空间分析技术，我们仔细分析了离散区域，包括头部,HL,近端茎区（距HL300-1000μm），和远端茎区域（距HL1500-2000μm），以识别空间上顺序的分子变化。我们的发现显示头部之间显著的整体基因表达变异，近端茎，与对照腺瘤相比，带蒂T1CRCs的远端茎区。与LNM阴性T1CRC相比，LNM阳性T1CRC显示参与免疫相关通路如B2M的基因表达,HLA-B,与近端茎区相比，远端茎区和HLA-E显著下调。总之,我们的结果可能暂时建议考虑内镜下切除距HL最小2000μm的茎，考虑到与免疫相关途径相关的基因表达改变。然而,我们承认这项试点研究的局限性，特别是小案例系列，这可能会限制解释的深度。进一步验证是必要的，以证实这些发现。
There is a debate regarding the prediction of lymph node metastasis (LNM) in
pedunculated T1 colorectal cancer (CRC). In this
study with four cases of
pedunculated T1 CRCs, we aimed to investigate gene expression variations based on the distance from the Haggitt line (HL) and identify potential molecular risk factors for LNM. By leveraging the Cancer Transcriptome Atlas and digital spatial profiling technology, we meticulously analyzed discrete regions, including the head, HL, proximal stalk region (300-1000 μm from HL), and distal stalk region (1500-2000 μm from HL) to identify spatially sequential molecular changes. Our findings showed significant overall gene expression variations among the head, proximal stalk, and distal stalk regions of
pedunculated T1 CRCs compared to the control adenoma. Compared to LNM-negative T1 CRCs, LNM-positive T1 CRC showed that the expression of genes involved in immune-related pathways such as B2M, HLA-B, and HLA-E were significantly downregulated in the distal stalk region compared to the proximal stalk region. In summary, our results may tentatively suggest considering endoscopic resection of the stalk with a minimum 2000 μm margin from the HL, taking into account the gene expression alterations related to immune-related pathways. However, we acknowledge the limitations of this pilot
study, notably the small case series, which may restrict the depth of interpretation. Further validation is imperative to substantiate these findings.
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