Characteristics of recurrence after curative resection for T1 colorectal cancer: Japanese multicenter study

Kobayashi, Hirotoshi; Mochizuki, Hidetaka; Morita, Takayuki; Kotake, Kenjiro; Teramoto, Tamio; Kameoka, Shingo; Saitō, Yukio; Takahashi, Keiichi; Hase, Kazuo; Oya, Mototsugu; Maeda, Koutarou; Hirai, Takashi; Kameyama, Masao; Shirouzu, Kazuo; Sugihara, Kenichi

doi:10.1007/s00535-010-0341-2

Cited by 106 publications

(92 citation statements)

References 37 publications

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“…(RR=1.33, 95% CI: 1.17-1.51; Fig. 3), which was consistent with the main results (4)(5)(6)11,12,(22)(23)(24).…”

Section: Sensitivity Analysissupporting

confidence: 80%

“…Stratification of patients according to the status of the muscularis mucosae (whether the muscle fibers were maintained or fragmented/disappeared), pathological factors and patient gender provides more appropriate indications for additional surgery along with lymph node dissection in this patient population, and may help reduce the incidence of unnecessary surgery. Several other studies also reported that the rate of LNM was higher in female compared with male patients (5,11), and that female gender was an independent risk factor for LNM in patients with T1 lower rectal cancer (23).…”

Section: Discussionmentioning

confidence: 95%

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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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“…(RR=1.33, 95% CI: 1.17-1.51; Fig. 3), which was consistent with the main results (4)(5)(6)11,12,(22)(23)(24).…”

Section: Sensitivity Analysissupporting

confidence: 80%

Section: Discussionmentioning

confidence: 95%

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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“…Nodal involvement is associated with an increased risk of local recurrence and shorter overall and disease-free survival time (18)(19)(20). Lymph node metastasis generally occurs in approximately 10% of patients with T1 colorectal carcinoma (8,9). In the clinical guidelines of the Japanese Society for Cancer of the Colon and Rectum (JSCCR), patients who undergo endoscopic resection for T1 colorectal carcinoma are considered to be at extremely low risk of developing lymph node metastasis if they have negative vertical margins, well or moderately differentiated adenocarcinoma, absence of vascular or lymphatic invasion, grade 0 or 1 tumor budding and submucosal invasion <1,000 µm (2).…”

Section: Discussionmentioning

confidence: 99%

“…Advanced anus-preserving low anterior resection and intersphincteric resection have become more common as treatments for lower rectal carcinoma that avoid colostomies (21). However, some anal function disorders and complications have been reported following such resections, reducing patient quality of life (8). Due to similar rates of lymph node metastasis in patients with colon and rectal T1 carcinoma, surgical indications following endoscopic resection should be similar.…”

Section: Discussionmentioning

confidence: 99%

“…In general, lymph node metastasis occurs in approximately 10% of patients with colorectal T1 carcinoma (8,9), therefore, it is essential to thoroughly assess the need for surgical resection in such patients. The present study was designed to compare the clinicopathological characteristics of patients with colon and rectal T1 carcinoma, and to determine whether these carcinomas should be considered as a single entity or two distinct entities when deciding on surgical treatment.…”

Section: Introductionmentioning

confidence: 99%

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Comparative clinicopathological characteristics of colon and rectal T1 carcinoma

et al. 2016

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Abstract. Lymph node metastasis significantly influences the management of patients with colorectal carcinoma. It has been observed that the biology of colorectal carcinoma differs by location. The aim of the current study was to retrospectively compare the clinicopathological characteristics of patients with colon and rectal T1 carcinomas, particularly their rates of lymph node metastasis. Of the 19,864 patients who underwent endoscopic or surgical resection of colorectal neoplasms at Showa University Northern Yokohama Hospital, 557 had T1 surgically resected carcinomas, including 457 patients with colon T1 carcinomas and 100 patients with rectal T1 carcinomas. Analysed clinicopathological features included patient age, gender, tumor size, morphology, tumor budding, invasion depth, vascular invasion, histological grade, lymphatic invasion and lymph node metastasis. Rectal T1 carcinomas were significantly larger than colon T1 carcinomas (mean ± standard deviation: 23.7±13.1 mm vs. 19.9±11.0 mm, P<0.01) and were accompanied by significantly higher rates of vascular invasion (48.0% vs. 30.2%, P<0.01). Significant differences were not observed among any other clinicopathological factors. In conclusion, tumor location itself was not a risk factor for lymph node metastasis in colorectal T1 carcinomas, even though on average, rectal T1 carcinomas were larger and accompanied by a significantly higher rate of vascular invasion than colon T1 carcinomas.

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Impact of subdivision of pathological stage I colorectal cancer

Fujii

Shimada

Tsukamoto

et al. 2020

Annals of Gastroent Surgery

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Aim Stage II‐IV colorectal cancers are subdivided according to TNM categories. However, stage I cases are a single category, despite the inclusion of both T1 and T2 cases, which may have different outcomes. The aim of this study was to evaluate the usefulness of subdividing stage I colorectal cancers by T category. Methods From 1984 to 2015, 844 patients with stage I colorectal cancer (T1: 446, T2: 398) underwent colorectal resection with lymph node dissection at three hospitals. The long‐term survival and recurrence rates were compared between T1 and T2. A Cox regression analysis was used to evaluate the risk factors associated with cancer recurrence. Results A comparison of the T1 and T2 groups revealed significant differences in 5‐year overall (95.9% vs 91.4%, P = .008), recurrence‐free (94.8% vs 87.1%, P = .0007), and cancer‐specific survival (97.6% vs 93.6%, P = .004), and in the overall (2.5% vs 6.8%, P = .003), local (0.2% vs 1.5%, P = .04), and lymph node recurrence rates (0.2% vs 1.5%, P = .04). All local and lymph node recurrences were associated with lower rectal cancer, and this difference was significant. The Cox multivariate analysis identified male sex (P = .01, hazard ratio: 4.00, 95% confidence interval: 1.38‐11.55), T2 (P = .02, hazard ratio: 2.98, 95% confidence interval: 1.17‐7.60), and venous invasion (P = .03, hazard ratio: 2.38, 95% confidence interval: 1.12‐5.10) as risk factors for recurrence. Conclusions The subdivision of stage I colorectal cancer according to T category clearly reflected the long‐term outcomes.

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Characteristics of recurrence after curative resection for T1 colorectal cancer: Japanese multicenter study

Abstract: The recurrence rate after curative resection for node-negative T1 colorectal cancer was very low. The effectiveness of surveillance to detect recurrence after curative resection for T1 colorectal cancer should be validated in further studies.

Cited by 106 publications

References 37 publications

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

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

Comparative clinicopathological characteristics of colon and rectal T1 carcinoma

Impact of subdivision of pathological stage I colorectal cancer

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