Long-term outcomes after treatment for pedunculated-type T1 colorectal carcinoma: a multicenter retrospective cohort study

Asayama, Naoki; Oka, Shiro; Tanaka, Shinji; Nagata, Shinji; Furudoi, Akira; Kuwai, Toshio; Onogawa, Seiji; Tamura, Tadamasa; Kanao, Hiroyuki; Hiraga, Yoshikazu; Okanobu, Hideharu; Kuwabara, Takayasu; Kitajima, Masaki; Mukai, Shuntaro; Goto, Eizo; Shimamoto, Fumio; Chayama, Kazuaki

doi:10.1007/s00535-015-1144-2

Cited by 25 publications

(38 citation statements)

References 33 publications

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“…Therefore, the predictive value of N stage should be reappraised according to T stage. Actually, in addition to N stage, many other predefined high‐risk clinical features, including poor differentiation, mucinous histology, and high CEA level, were infrequently found in T1 stage colon cancer . Hence, using these factors alone to predict survival of T1 stage colon cancer may not be reliable.…”

Section: Discussionmentioning

confidence: 99%

The Critical Role of Tumor Size in Predicting Prognosis for T1 Colon Cancer

Dai

Xiang

et al. 2019

The Oncologist

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Background The role of horizontal growth index of tumor size in survival prediction is still underappreciated in colon cancer because of the identification of vertical infiltration index reflected by T stage. We sought to reveal the impact of T stage on the prognostic and predictive value of tumor size in colon cancer. Materials and Methods Data of patients with stage I–III colon cancer were extracted from Surveillance, Epidemiology, and End Results Program (SEER) and Fudan University Shanghai Cancer Center (FUSCC) databases. Harrell's concordance index (c‐index) and time‐dependent receiver operating characteristic curve (ROC) were used to analyze the discriminative ability of prognostic factors. Results Stratified analyses based on T stage found that the increase of T stage significantly and negatively repressed the effect of tumor size on death and recurrence risk. In addition, tumor size showed the greatest hazard ratio of cancer‐specific death and relapse in T1 colon cancer. Even more importantly, the discriminatory ability of tumor size outperformed any other widely accepted prognostic clinical features in predicting cancer‐specific survival (SEER: c‐index 0.637, area under the ROC [AUC] 0.649; FUSCC: c‐index 0.673, AUC 0.686) and disease‐free survival (FUSCC: c‐index 0.645, AUC 0.656) in T1 stage colon cancer. Conclusion Tumor size is a critical clinical factor with considerable prognostic and predictive value for T1 colon cancer, and it should be selectively incorporated into the current staging system to facilitate prediction of death and recurrence risk. Implications for Practice To date, no consensus has been reached about the prognostic and predictive value of tumor size in colon cancer. Although tumor size is an independent prognostic factor for patients with colon cancer, the impact of tumor size on death or recurrence risk decreased notably with the increase of T stage. More importantly, the discriminative ability of tumor size outperformed any other clinical factors including N stage in patients with T1 colon cancer. Therefore, tumor size should be recommended to be incorporated into current staging systems to facilitate prognosis prediction for patients with T1 colon cancer.

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Section: Discussionmentioning

confidence: 99%

The Critical Role of Tumor Size in Predicting Prognosis for T1 Colon Cancer

Dai

Xiang

et al. 2019

The Oncologist

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“…Although they have been thoroughly analyzed, the risk factors for LNM in T1 colon cancer remain controversial. Moreover, several independent factors have been proposed; however, none can reliably distinguish between patients having T1 colon cancer without LNM from those with LNM.…”

Section: Introductionmentioning

confidence: 99%

Incidence, risk factors, and a predictive model for lymph node metastasis of submucosal (T1) colon cancer: A population‐based study

Cao

et al. 2019

J of Digest Diseases

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Objective: This study aimed to assess the incidence, identify independent factors, and develop a lymph node metastasis (LNM) prediction model for patients with T1 colon cancer.Methods: Statistics were drawn from the Surveillance, Epidemiology, and End Results database between 2004 and 2014. A multivariate logistic regression analysis was performed to determine independent predictors of LNM. A nomogram for predicting the possibility of LNM was developed based on those factors.Results: A total of 5397 patients with T1 colon cancer were identified. The overall LNM rate was 15.0% (808/5397). A multivariate analysis showed that age (odds ratio [OR] 0.97, P < 0.001), tumor size (OR 1.01, P < 0.001), moderate (OR 1.77, P = 0.001) or poorly differentiated/undifferentiated tumor (OR 5.60, P < 0.001), right colon cancer (OR 1.39, P = 0.008), and a positive carcinoembryonic antigen level (OR 1.51, P = 0.004) were independent predictive factors for LNM. The area under the receiver operating characteristic curve was 0.68 (95% confidence interval [CI] 0.65-0.71) in the training set and 0.65 (95% CI 0.61-0.67) in the validation set. A calibration plot showed good consistency between the bias-corrected prediction and the ideal reference line with 1000 additional bootstraps (mean absolute error = 0.007).Conclusions: The incidence of LNM was high in patients with T1 colon cancer. A nomogram for predicting the probability of LNM for T1 colon cancer may be used to help determine the optimal treatment for these patients. K E Y W O R D Scolonic neoplasms, lymphatic metastasis, nomogram, predictive factor, SEER program

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“…Indications for ER methods for colorectal tumors are shown in Figure . Pedunculated‐type tumors including T1 carcinoma receive polypectomy as the initial ER method, because the histological en bloc resection rate is high and, consequently, the rate of adverse events is extremely low . Colorectal ESD has been standardized in Japan, and is the first‐choice procedure for non‐pedunculated‐type tumors large than 20 mm in diameter in which en bloc resection using conventional EMR is difficult or impossible.…”

Section: Discussionmentioning

confidence: 99%

“…Pedunculatedtype tumors without clinical stalk invasion are an indication of polypectomy regardless of tumor size. 13,14 In actual clinical situations, the respondents thoroughly applied the indications for colorectal ESD proposed by the Colorectal ESD Standardization Implementation Working Group as follows: (i) large lesions in which en bloc resection using snare EMR is difficult: laterally spreading tumor nongranular type (LST-NG), lesions showing type V I pit pattern, cancer with submucosal infiltration and large lesions of the elevated type suspected of being cancerous; (ii) mucosal lesions with fibrosis caused by prolapse as a result of biopsy or peristalsis of the lesion; (iii) local residual early carcinoma with ulcer scar after ER; and (iv) sporadic localized tumors in chronic inflammation such as ulcerative colitis. 1 Treatment strategy for choosing between EMR and ESD should be discussed based on the clinicopathological characteristics of the tumors, endoscopist skill level, and patient condition.…”

Section: Q1: Please Explain Your Indication For Emr or Esd For Colorementioning

confidence: 99%

“…Pedunculated-type tumors including T1 carcinoma receive polypectomy as the initial ER method, because the histological en bloc resection rate is high and, consequently, the rate of adverse events is extremely low. 13,14 Colorectal ESD has been standardized in Japan, and is the first-choice procedure for non-pedunculated-type tumors large than 20 mm in diameter in which en bloc resection using conventional EMR is difficult or impossible. However, conventional EMR is a standard ER method for nonpedunculated-type tumors from 10 mm to 19 mm in diameter when en bloc resection is possible.…”

Section: Uring the Lower -Gi Session At The Efj In 2016mentioning

confidence: 99%

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Standardization of endoscopic resection for colorectal tumors larger than 10 mm in diameter

Oka

Uraoka

Tamai

et al. 2017

Digestive Endoscopy

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Currently, several endoscopic resection (ER) methods for colorectal tumors are available, including polypectomy, conventional endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), and modified ER. In the present review, we mainly focus on the current status of ER for colorectal tumors as well as the report from the Endoscopic Forum Japan (EFJ) 2016, which was held in Tokyo in August 2016. The proposed ER methods for colorectal tumors larger than 10 mm in diameter are as follows. (i) Pedunculated-type tumor is an indication for polypectomy, regardless of size. (ii) Non-pedunculated-type tumor larger than 20 mm in diameter is an indication for ESD in which en bloc resection using conventional EMR is difficult or impossible. (iii) Non-pedunculated-type tumor from 10 mm to 20 mm in diameter is an indication for conventional EMR. However, ESD or modified ER methods are acceptable according to the procedure and the condition of the tumor.

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Long-term outcomes after treatment for pedunculated-type T1 colorectal carcinoma: a multicenter retrospective cohort study

Abstract: Our data support the validity of the JSCCR curative criteria for pedunculated-type T1 CRCs. Endoscopic resection cannot be considered curative for pedunculated-type T1 CRC with head invasion alone.

Cited by 25 publications

References 33 publications

The Critical Role of Tumor Size in Predicting Prognosis for T1 Colon Cancer

The Critical Role of Tumor Size in Predicting Prognosis for T1 Colon Cancer

Incidence, risk factors, and a predictive model for lymph node metastasis of submucosal (T1) colon cancer: A population‐based study

Standardization of endoscopic resection for colorectal tumors larger than 10 mm in diameter

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