Clinicopathological features of T1 colorectal carcinomas with skip lymphovascular invasion

Sato, Yuta; Kudo, Shin‐ei; Ichimasa, Katsuro; Matsudaira, Shingo; Kouyama, Yuta; Kato, Kazúo; Baba, Toshiyuki; Wakamura, Kunihiko; Hayashi, Takemasa; Kudo, Toyoki; Ogata, Noriyuki; Mori, Yuichi; Misawa, Masashi; Toyoshima, Naoya; Ishigaki, Tomoyuki; Yagawa, Yusuke; Nakamura, Hiroki; Sakurai, Tatsuya; Shakuo, Yukiko; Suzuki, Kenichi; Kudo, Yoshihisa; Hamatani, Shigeharu; Ishida, Fumio; Miyachi, Hideyuki

doi:10.3892/ol.2018.9527

Cited by 3 publications

(5 citation statements)

References 24 publications

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“…Interestingly, both recurrences were T3 cancers despite negative vertical margins, possibly explained by other factors increasing risk of recurrence such as skip lymphovascular invasion or tumor budding beyond the resection margin. [17][18][19] In conclusion, the risk of recurrence within 12 months after a complete ESD with positive horizontal resection margins is very low for non-invasive lesions. Postponing the first follow-up endoscopy to 12 months after initial resection might be justified for non-invasive lesions.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

“…It is questionable whether this reflects the actual risk of recurrence within T1 CRCs, and therefore this requires further study. Interestingly, both recurrences were T3 cancers despite negative vertical margins, possibly explained by other factors increasing the risk of recurrence, such as skip lymphovascular invasion or tumor budding beyond the resection margin [17][18][19].…”

Section: Follow-up Time and Detected Recurrencementioning

confidence: 99%

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Low risk of local recurrence after a successful en bloc endoscopic submucosal dissection for noninvasive colorectal lesions with positive horizontal resection margins (R-ESD study)

et al. 2022

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Background During endoscopic submucosal dissection (ESD), normal mucosa is cut under constant optical control. We studied whether a positive horizontal resection margin after a complete en bloc ESD predicts local recurrence. Methods In this European multicenter cohort study, patients with a complete en bloc colorectal ESD were selected from prospective registries. Cases were defined by a horizontal resection margin positive or indeterminate for dysplasia (HM1), whereas controls had a free resection margin (HM0). Low-risk lesions with submucosal invasion (T1) and margins free of carcinoma were analysed seperately. The main outcome was local recurrence. Results From 928 consecutive ESDs (2011-2020), 354 patients (40% female, mean age 67 years, median follow-up 23.6 months) were included concerning 308 non-invasive lesions and 46 T1 lesions. Recurrence rate for non-invasive lesions was 1/212 (0.5%; 95%CI 0.02-2.6%) for HM0 vs. 2/96 (2.1%; 95%CI 0.57-7.3%) for HM1. Recurrence rate for T1 was 1/38 (2.6%; 95%CI 0.14-13.5%) for HM0 vs. 2/8 (25%; 95%CI 7.2-59%) for HM1. Conclusion A positive horizontal resection margin after an en bloc ESD for non-invasive lesions is associated with a marginal non-significant increase of the local recurrence rate, equal to an ESD with clear horizontal margins. This could not be confirmed for T1 lesions.

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Section: Accepted Manuscriptmentioning

confidence: 99%

Section: Follow-up Time and Detected Recurrencementioning

confidence: 99%

Low risk of local recurrence after a successful en bloc endoscopic submucosal dissection for noninvasive colorectal lesions with positive horizontal resection margins (R-ESD study)

et al. 2022

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“…Currently, there is a debate about the importance of the different histopathological criteria and their respective weight in assessing the risk of lymph node recurrence. While significant budding 5 19 20 21 22 , LVI 5 22 23 24 , and poorly differentiated components are clearly recognized as pejorative criteria, depth of invasion beyond 1000 µm is increasingly being questioned 5 25 . In the present study, no focal or metastatic tumor recurrence was reported for very low risk lesions considered cured by ESD; however, we cannot exclude a significant risk of recurrence, particularly for low risk lesions.…”

Section: Discussionmentioning

confidence: 99%

“…Despite the small sample size of our study, the discussion about the new threshold of acceptable sm invasion is open since none of the patients with LR T1 cancers with sm invasion between 1000 and 2000 m experienced recurrence or lymph node involvement. This 2000 m threshold has already been reported in a large Japanese study [24]. Systematically referring lesions with FDIP to surgical treatment may not be adequate, particularly for elderly patients or those presenting several comorbidities.…”

Section: Accepted Manuscriptmentioning

confidence: 90%

Diagnostic endoscopic submucosal dissection for colorectal lesions with suspected deep invasion

et al. 2022

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Introduction: Endoscopic submucosal dissection (ESD) is potentially a curative treatment of T1 colorectal cancer in certain condition. The aim of the study was to evaluate the feasibility and effectiveness of ESD on lesions with suspicion of focal deep invasion. Methods: In this retrospective multicenter study, consecutive patients with colorectal neoplasia displaying focal (< 15 mm) deep invasive patterns (FDIP) treated by ESD were included. We excluded ulcerated lesions (Paris III), lesions with distant metastasis, and clearly advanced tumors (tumoral strictures). Results: A total of 124 patients benefited from 126 diagnostic dissection attempts for FDIP lesions. Dissection was feasible in 120/126 (95.2%) cases. When possible, En bloc and R0 resection rate were respectively 95.8% (115/120) and 76.7% (92/120). Thirty-three (26.2%) resections were treated curatively for very low risk tumors and 38 (30.2%) were considered as low risk. Non-curative R0 resections concerned lesions with lymphatic or vascular invasion (LVI) (n=8), or significant budding (n=9), and LVI + budding association (n=4). Conclusion: ESD is feasible and safe for colorectal lesions with FDIP ≤ 15 mm. It cured 26.2% of patients and could be a valid option for 30.2% of additional patients with low-risk T1 cancers, especially for fragile patients with comorbidities.

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“…The study suggested that skip lymphovascular invasion was associated with hepatic metastasis in CRC cases. Yuta sato et al (19) have analyzed the clinicopathological features of T1 CRC with SLVI and indicated that lymphovascular invasion was a significant risk factor for SLVI in T1 CRC. The above three studies consistently implicated the possible existence of an undefined group of T1 CRC.…”

Section: Discussionmentioning

confidence: 99%

Early T Stage Is Associated With Poor Prognosis in Patients With Metastatic Liver Colorectal Cancer

Fu²,

Chen

et al. 2020

Front. Oncol.

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Clinically, a considerable portion of patients with early T stage who were supposed to have a low distant metastatic probability were diagnosed with metastatic liver colorectal cancer (CRLM). Our study aims to evaluate the prognostic value of the T stage for metastatic patients and establish a convenient individual assessment model for clinicians to explore preoperative predictors. The mRNA profiles of colorectal tumors (N = 19) were obtained by microarray at our clinical center. A total of 5,618 patients with CRLM from 2010 to 2015 were enrolled for the Surveillance, Epidemiology, and End Results (SEER) database. The cDNA microarray analyses showed that gene expression pattern in the T2N0M1 subgroup was significantly different from the T3/4N0M0 subgroup. In the survival analysis, metastatic patients with T1 stage surprisingly had much poorer prognosis than those with T3/T4 stage. Specifically, metastatic patients with early T stage were observed with higher frequency occurring at the rectum, better differentiation, less metastases in the lymph nodes, and a higher CEA level. Further survival analysis indicated that early T classification was an independent prognostic factor for a poor survival. When the lymph node (N) status was taken into consideration, patients with T1/2N+ had better survival than T1/2N0 patients. A clinical nomogram was constructed based on preoperative factors. The calibration curves showed a good concordance between nomogram prediction and actual observation. In conclusion, CRLM with early T stage had a different biological background. The prognosis of patients at T1/2M1 was poorer than at T3/4M1. More attention should be paid to the surveillance of high-risk factors and the screening of early T stage.

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Clinicopathological features of T1 colorectal carcinomas with skip lymphovascular invasion

Cited by 3 publications

References 24 publications

Low risk of local recurrence after a successful en bloc endoscopic submucosal dissection for noninvasive colorectal lesions with positive horizontal resection margins (R-ESD study)

Low risk of local recurrence after a successful en bloc endoscopic submucosal dissection for noninvasive colorectal lesions with positive horizontal resection margins (R-ESD study)

Diagnostic endoscopic submucosal dissection for colorectal lesions with suspected deep invasion

Early T Stage Is Associated With Poor Prognosis in Patients With Metastatic Liver Colorectal Cancer

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