A clinical model for predicting lymph node metastasis in submucosal invasive (T1) colorectal cancer

Macias-García, Fernando; Celeiro-Muñoz, Catuxa; Lesquereux-Martínez, Lucía; Gude‐Sampedro, Francisco; Uribarri-Gonzalez, Laura; Abdulkader, Ihab; Álvarez-Castro, Ana; Domínguez–Muñoz, J. Enrique

doi:10.1007/s00384-015-2164-3

Cited by 35 publications

(33 citation statements)

References 35 publications

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“…The literature search revealed 2728 publications ( Figure 2 ). Of the 143 included for full text review, 34 were ultimately included in the meta-analysis ( Hase et al , 1993 ; Ueno et al , 2002a ; Okuyama et al , 2003a , 2003b ; Ueno et al , 2004 ; Prall et al , 2005 ; Wang et al , 2005 ; Yasuda et al , 2007 ; Kanazawa et al , 2008 ; Nakamura et al , 2008 ; Yamauchi et al , 2008 ; Lugli et al , 2009 ; Ogawa et al , 2009 ; Wang et al , 2009 ; Homma et al , 2010 ; Kajiwara et al , 2010 ; Komori et al , 2010 ; Tateishi et al , 2010 ; Akishima-Fukasawa et al , 2011 ; Reggiani Bonetti et al , 2011 ; Betge et al , 2012 ; Nakadoi et al , 2012 ; Sert Bektas et al , 2012 ; Zlobec et al , 2012 ; Wada et al , 2013 ; Huh et al , 2014 ; Lai et al , 2014 ; Nishida et al , 2014 ; Ryu et al , 2014 ; Gilardoni et al , 2015 ; Macias-Garcia et al , 2015 ; Miyachi et al , 2015 ; Tristante et al , 2015 ; Barresi et al , 2016 ). There were a total of 7821 patients included for analysis, with study groups ranging from 58 to 1114 patients.…”

Section: Resultsmentioning

confidence: 99%

“…There were considerable differences and an overt lack of standardisation of tumour budding between studies ( Table 2 ). Twenty-eight studies used standard haematoxylin and eosin (H&E) staining, four studies used immunohistochemistry (IHC) and cytokeratin staining ( Prall et al , 2005 ; Lugli et al , 2009 ; Ogawa et al , 2009 ; Zlobec et al , 2012 ), and two did not specify the technique ( Gilardoni et al , 2015 ; Macias-Garcia et al , 2015 ), although one could assume standard H&E was used. A ‘budding focus' or its equivalent was defined as an isolated cancer cell or cluster of less than five cells in 24 studies.…”

Section: Resultsmentioning

confidence: 99%

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Systematic review and meta-analysis of the impact of tumour budding in colorectal cancer

et al. 2016

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Background:Tumour budding is a histological finding in epithelial cancers indicating an unfavourable phenotype. Previous studies have demonstrated that it is a negative prognostic indicator in colorectal cancer (CRC), and has been proposed as an additional factor to incorporate into staging protocols.Methods:A systematic review of papers until March 2016 published on Embase, Medline, PubMed, PubMed Central and Cochrane databases pertaining to tumour budding in CRC was performed. Study end points were the presence of lymph node metastases, recurrence (local and distal) and 5-year cancer-related death.Results:A total of 7821 patients from 34 papers were included, with a mean rate of tumour budding of 36.8±16.5%. Pooled analysis suggested that specimens exhibiting tumour budding were significantly associated with lymph node positivity (OR 4.94, 95% CI 3.96–6.17, P<0.00001), more likely to develop disease recurrence over the time period (OR 5.50, 95% CI 3.64–8.29, P<0.00001) and more likely to lead to cancer-related death at 5 years (OR 4.51, 95% CI 2.55–7.99, P<0.00001).Conclusions:Tumour budding in CRC is strongly predictive of lymph node metastases, recurrence and cancer-related death at 5 years, and its incorporation into the CRC staging algorithm will contribute to more effective risk stratification.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Systematic review and meta-analysis of the impact of tumour budding in colorectal cancer

et al. 2016

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“…Third, all the studies in this meta-analysis originated in Japan, which may have affected our results. Only 3 of the 36 studies were from western countries, none of which reported adjusted results, and were thus excluded from the current criteria (28,30,48). In fact, these 3 studies showed a tendency of higher LNM rate in female rather than in male patients, but the difference was not significant due to insufficient number (<100) of study subjects.…”

Section: Discussionmentioning

confidence: 99%

Patient gender as a factor associated with lymph node metastasis in T1 colorectal cancer: A systematic review and meta-analysis

Ichimasa

Kudo

Miyachi

et al. 2017

Molecular and Clinical Oncology

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Abstract. Approximately 10% of patients with T1 colorectal cancer have lymph node metastases (LNM), requiring node dissection along with surgical resection. Patient gender was recently reported to affect the occurrence of LNM. The aim of the present study was to assess whether patient gender was predictive of LNM in T1 colorectal cancer. Public databases, including PubMed, EMBASE and the Cochrane Central Register of Controlled Trials were searched, using key terms related to 'T1 colorectal cancer' and 'lymph node'. All relevant studies reporting the adjusted odds ratio or risk ratio of LNM in relation to patient gender were included. The quality of the studies was classified according to the Quality in Prognostic Studies tool. A random-effects model was used and the quality of the evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation approach. The initial database search identified 2,492 publications; of those, 36 studies reported unadjusted results. Of the 36 studies, 4 reported adjusted results and fulfilled the inclusion criteria for this meta-analysis: 3 studies were graded as having a moderate risk of bias, and 1 had a low risk of bias.The present meta-analysis demonstrated that female gender was associated with increased risk of LNM (risk ratio=2.45, 95% confidence interval: 1.03-3.88). The I 2 statistic was 0.901, classified as very low (+OOO) and was downgraded by the risk of bias, inconsistency and publication bias. In conclusion, female gender was found to be correlated with LNM in patients with T1 colorectal cancer. IntroductionColorectal cancer is one of the most common types of cancer worldwide. Due to the advances in endoscopic treatment, particularly endoscopic submucosal dissection, several T1 colorectal cancers are resected endoscopically with negative margins (1-3). Lymph node metastasis (LNM) occurs in ~10% of patients with T1 colorectal cancer, with these patients requiring surgical resection with lymph node dissection (4-7). Therefore, determining risk factors associated with LNM in patients with T1 colorectal cancer is crucial.A number of studies have assessed factors predictive of LNM in patients with T1 colorectal cancer. Previously identified risk factors for LNM include lymphovascular invasion, histological grade, tumor budding and degree of submucosal invasion (8-10). These factors are included in various diagnostic and treatment guidelines, including those of the National Comprehensive Cancer Network, the European Society for Medical Oncology and the Japanese Society for Cancer of the Colon and Rectum (8-10). However, the majority of the studies identifying these guidelines were retrospective in design and included small numbers of patients. In addition, these analyses were limited to pathological factors. The indications for additional surgery plus lymph node dissection following endoscopic resection remain unclear.A recent retrospective, single-center study, which included a large number of patients, reported that female gender was associ...

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“…The risk for regional lymph node metastasis is reported up to 14 percents of patients with T1 colorectal cancer 15, 16. Combing risk factors of lymph node metastasis, including large tumor size, old age, lymphatic invasion, submucosal invasion (≥1 mm), and poor differentiation, with high‐resonance magnetic imaging and computed tomography 12, 17, 18, 19, surgeons can identify patients with lower risk for lymph node metastasis, which are, by definition, clinic N0.…”

Section: Discussionmentioning

confidence: 99%

Long‐term oncological outcomes of local excision versus radical resection for early colorectal cancer in young patients without preoperative chemoradiotherapy: a population‐based propensity matching study

et al. 2018

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The incidence and mortality of colorectal carcinoma are rising in young adults. This population‐based propensity matching study aimed to compare long‐term oncological outcomes of local excision with radical resection for early localized colorectal cancer (CRC) in young patients without preoperative chemoradiotherapy. Patients under 45 years old with T1 colon or rectal adenocarcinoma who underwent local excision or radical resection were included from the Surveillance, Epidemiology, and End Results (SEER) database between 1998 and 2014. Survival curves were plotted using the Kaplan–Meier method. Cancer‐specific survival (CSS) was compared using adjusted hazard ratios (HRs) between local excision and radical resection. After propensity score matching procedure, total of 1719 patients were included in the analysis, among which 573 treated with local excision and 1146 treated with radical resection. The median follow‐up was 80 months (interquartile range(IQR): 37–132), with 1074 patients followed for ≥5 years and 508 patients followed for ≥10 years. Five‐year CSS of local excision versus radical resection was 93.4% versus 96.7% for colon cancer and 96.6% versus 98.4% for rectal cancer. Ten‐year CSS of local excision versus radical resection was 91.4% versus 94.0% for colon cancer and 92.8% versus 96.7% for rectal cancer. On multivariable analysis, compared with radical resection, local excision was not associated with inferior CSS for colon (HR 1.74, 95% CI: 0.92–3.29, P = 0.090) and rectal cancer (HR 2.16, 95% CI: 0.99–4.71, P = 0.052). There is no evidence of differential long‐term oncological outcomes between local excision and radical resection. These findings supported clinical application of local excision for early colon and rectal cancer in young adults.

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A clinical model for predicting lymph node metastasis in submucosal invasive (T1) colorectal cancer

Cited by 35 publications

References 35 publications

Systematic review and meta-analysis of the impact of tumour budding in colorectal cancer

Systematic review and meta-analysis of the impact of tumour budding in colorectal cancer

Patient gender as a factor associated with lymph node metastasis in T1 colorectal cancer: A systematic review and meta-analysis

Long‐term oncological outcomes of local excision versus radical resection for early colorectal cancer in young patients without preoperative chemoradiotherapy: a population‐based propensity matching study

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