Histopathologic risk factors for lymph node metastasis in patients with T1 colorectal cancer

Ha, Ryun; Han, Kyung Su; Sohn, Dae Kyung; Kim, Jae Hak; Hong, Chang Won; Chang, Hee Jin; Hyun, Jong Hee; Kim, Min Jung; Park, Sung Chan; Oh, Jae Hwan

doi:10.4174/astr.2017.93.5.266

Cited by 47 publications

(48 citation statements)

References 20 publications

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“…This finding agrees with three recently published studies manifesting that lymphatic invasion is causally associated with the risk of LNM in CRC [47][48][49]. Tumor budding is recognized as a negative prognostic risk factor for LNM in CRC, and our findings are concordant with previous studies [50][51][52]. Individual component studies vary in their definitions of tumor budding (e.g., how many cancer cells comprise a tumor bud, and how many buds signify tumor budding) and vary in the pathologic staining methods to detect tumor budding (e.g., hematoxylin and eosin [H&E], immunohistochemistry [IHC]).…”

Section: Discussionsupporting

confidence: 94%

Risk factors and risk prediction models for colorectal cancer metastasis and recurrence: an umbrella review of systematic reviews and meta-analyses of observational studies

Wang

et al. 2020

BMC Med

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Background: There is a clear need for systematic appraisal of models/factors predicting colorectal cancer (CRC) metastasis and recurrence because clinical decisions about adjuvant treatment are taken on the basis of such variables. Methods: We conducted an umbrella review of all systematic reviews of observational studies (with/without metaanalysis) that evaluated risk factors of CRC metastasis and recurrence. We also generated an updated synthesis of risk prediction models for CRC metastasis and recurrence. We cross-assessed individual risk factors and risk prediction models. Results: Thirty-four risk factors for CRC metastasis and 17 for recurrence were investigated. Twelve of 34 and 4/17 risk factors with p < 0.05 were estimated to change the odds of the outcome at least 3-fold. Only one risk factor (vascular invasion for lymph node metastasis [LNM] in pT1 CRC) presented convincing evidence. We identified 24 CRC risk prediction models. Across 12 metastasis models, six out of 27 unique predictors were assessed in the umbrella review and four of them changed the odds of the outcome at least 3-fold. Across 12 recurrence models, five out of 25 unique predictors were assessed in the umbrella review and only one changed the odds of the outcome at least 3-fold. Conclusions: This study provides an in-depth evaluation and cross-assessment of 51 risk factors and 24 prediction models. Our findings suggest that a minority of influential risk factors are employed in prediction models, which indicates the need for a more rigorous and systematic model construction process following evidence-based methods.

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Section: Discussionsupporting

confidence: 94%

Risk factors and risk prediction models for colorectal cancer metastasis and recurrence: an umbrella review of systematic reviews and meta-analyses of observational studies

Wang

et al. 2020

BMC Med

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“…[197][198][199][200][201][202] Multivariate analyses have shown that poor histologic types (poorly differentiated adenocarcinoma, signet ring cell carcinoma, mucinous carcinoma) have increased ORs (2.93-45.9) for lymph node metastasis compared with well differentiated adenocarcinomas. [203][204][205] Four meta-analyses also showed early colorectal cancers with poor histologic types to have an increased risk of lymph node metastasis with ORs ranging between 4.78 and 8.27. 8,[206][207][208] Well differentiated intramucosal colorectal cancer does not metastasize to the lymph nodes, whereas 6%-20% of early colorectal cancers that invade the submucosa metastasize to the lymph nodes.…”

Section: Statement G13mentioning

confidence: 99%

“…[210][211][212] The risk of lymph node metastasis increases in proportion to the depth of submucosal invasion determined by these classification methods (Haggitt level 4 and Kudo sm2-3). [197][198][199]205,209,213,214 In studies that measured the absolute depth of submucosal invasion from the muscularis mucosa and evaluated the risk of lymph node metastasis, depth of vertical invasion of ≥1,000 μm of nonpedunculated cancer were associated with the risk of lymph node metastasis, and the risk increased in proportion to the depth of invasion. 201,203,[215][216][217][218][219] In meta-analyses evaluating the risk of lymph node metastases in colorectal cancer, depth of submucosal invasion of ≥1,000 μm increased the OR of lymph node metastasis to 3.0-5.93.…”

Section: Statement G13mentioning

confidence: 99%

“…In many studies including multivariate analyses, lymphovascular invasion was an independent risk factor for predicting local lymph node metastasis. [198][199][200][201][202][203][204][205]220 There have been five meta-analyses that evaluated the risks for lymph node metastasis according to lymphatic and vascular invasion; lymphatic invasion (OR, 4.15-6.91), vascular invasion (OR, 2.20-4.03), and lymphovascular (either lymphatic or vascular) invasion (OR, 3.9-5.47) all had increased lymph node metastases. 8,[206][207][208]221 Tumor budding is defined as the presence of a single tumor cell or a cluster of <5 tumor cells at the tumor-invasive front of resected specimens.…”

Section: Early Colorectal Cancermentioning

confidence: 99%

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Clinical Practice Guideline for Endoscopic Resection of Early Gastrointestinal Cancer

et al. 2020

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Although surgery was the standard treatment for early gastrointestinal cancers, endoscopic resection is now a standard treatment for early gastrointestinal cancers without regional lymph node metastasis. High-definition white light endoscopy, chromoendoscopy, and image-enhanced endoscopy such as narrow band imaging are performed to assess the edge and depth of early gastrointestinal cancers for delineation of resection boundaries and prediction of the possibility of lymph node metastasis before the decision of endoscopic resection. Endoscopic mucosal resection and/or endoscopic submucosal dissection can be performed to remove early gastrointestinal cancers completely by en bloc fashion. Histopathological evaluation should be carefully made to investigate the presence of risk factors for lymph node metastasis such as depth of cancer invasion and lymphovascular invasion. Additional treatment such as radical surgery with regional lymphadenectomy should be considered if the endoscopically resected specimen shows risk factors for lymph node metastasis. This is the first Korean clinical practice guideline for endoscopic resection of early gastrointestinal cancer. This guideline was developed by using mainly de novo methods and encompasses endoscopic management of superficial esophageal squamous cell carcinoma, early gastric cancer, and early colorectal cancer. This guideline will be revised as new data on early gastrointestinal cancer are collected.

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“…An isolated cell or a small cluster of fewer than 5 carcinoma cells in the invasive front was defined as a budding focus, with positive tumor budding defined as more than 10 budding foci viewed at 200-fold magnification [8]. According to our previous study, the risk factors for lymph node metastasis (LNM) contain deep SM invasion (sm2 or sm3), vascular invasion, high histological grade, budding [9], and pathological diagnoses were performed by a board-certified pathologist (HJC).…”

Section: Patient Recruitment and Stratificationmentioning

confidence: 99%

Characteristics of minute T1 colorectal cancer in relevance to pathology and treatment

Park

Roh

et al. 2020

Ann Surg Treat Res

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Purpose: Minute T1 colorectal cancer (CRC) lesions (≤5 mm) are rare; however, little is known about their characteristics and aggressiveness. In this study, we evaluated the characteristics of minute T1 CRC in relevance to pathology and treatment. Methods: This retrospective study included 849 patients with T1 CRC endoscopically or surgically treated between January 2001 and December 2016. The patients were stratified into 4 groups according to tumor size; minute group (≤5 mm), small group (6-10 mm), medium group (11-20 mm), and large group (≥21 mm). Clinicopathological variables were evaluated with respect to tumor size. Results: The incidence of the minute T1 CRC was 2.4% (20 of 849). Minute T1 CRC was significantly associated with flat type (

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Histopathologic risk factors for lymph node metastasis in patients with T1 colorectal cancer

Cited by 47 publications

References 20 publications

Risk factors and risk prediction models for colorectal cancer metastasis and recurrence: an umbrella review of systematic reviews and meta-analyses of observational studies

Risk factors and risk prediction models for colorectal cancer metastasis and recurrence: an umbrella review of systematic reviews and meta-analyses of observational studies

Clinical Practice Guideline for Endoscopic Resection of Early Gastrointestinal Cancer

Characteristics of minute T1 colorectal cancer in relevance to pathology and treatment

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