<p>Pathological risk factors for lymph node metastasis in patients with submucosal invasive colorectal carcinoma</p>

Abstract

BackgroundRisk grade assessment determines therapy in patients with submucosal invasive colorectal carcinoma (CRC). However, treatment decisions are often difficult due to a lack of consensus on which risk factors should be considered. We aimed to identify predictive risk factors for lymph node metastasis (LNM) in a large cohort of submucosal invasive CRC patients from China.Patients and methodsFollowing collection of clinicopathological data and disease-free survival (DFS) rates from 290 patients who underwent radical intestinal resection with regional lymphadenectomy, we immunohistochemically assessed expression of DNA mismatch repair (MMR) proteins and p53. The correlation between clinicopathological parameters, MMR expression, p53 status, and LNM status was determined using chi-squared tests and logistic analysis. Receiver operator characteristic curve analysis was used to compare the predictive values. The DFS curves were plotted using the Kaplan–Meier method.ResultsLNM was detected in 15.5% of the cases (45/290 patients). Three pathological characteristics, high tumor differentiation grade, lymphovascular invasion (LVI), and tumor budding, were all positively related to LNM in univariate and multivariate analyses (P<0.05). MMR status did not correlate with either LNM or the pathological characteristics (P>0.05). Overexpression of p53 was associated with tumor budding status (P=0.036). With a negative predicative value of 0.92 and area under the curve of 0.76 (95% CI: 0.68–0.85), the combination of these three factors provided optimal predictive ability. Patients with all three risk factors had poorer DFS (P<0.001).ConclusionHigh tumor grade, LVI, and positive tumor budding serve as useful LNM predictors in submucosal invasive CRC.

Long-term Outcomes of Primary Endoscopic Resection vs Surgery for T1 Colorectal Cancer: A Systematic Review and Meta-analysis

“…Although the evidence is too insufficient to draw a conclusion, recent studies have suggested that T1 CRC with invasion deeper than 1000 mm may be considered low-risk as long as other risk factors are absent. [37][38][39] We expect to obtain additional evidence regarding this matter in the future, which will enable treatment decisions to be made with greater precision. This is a systematic review for the long-term prognosis of T1 CRC between ER and surgery, and the strengths of our study arise from the comprehensive inclusion and review of currently available studies and meticulous analyses for major outcomes and among different subgroups.…”

Diagnostic value of NSE factor combined with ultrasound hemodynamic indexes in cervical lymph node metastasis of lung cancer

“…The main non-invasive diagnostic method is enhanced CT and PDG-PET, however, they both involve radiation exposure that some patients are unwilling to accept (15). In recent years, with the development of molecular biology, the application of serum tumor markers in the auxiliary diagnosis of lung cancer and the monitoring of recurrence and metastasis has achieved good results (16,17). NSE is recognized as a highly sensitive tumor marker in lung cancer.…”

Endoscopic Recognition and Management Strategies for Malignant Colorectal Polyps: Recommendations of the US Multi-Society Task Force on Colorectal Cancer

“…11 A recent study with 290 patients with endoscopically resected malignant polyps who underwent surgical resection also reported tumor budding as one of the risk factors for LNM, found in 42% of tumors with LNM compared with 18% in LNM-negative tumors (OR, 2.3; 95% CI, 1.1-5.0). 76 Recently, recommendations of an international Tumor Budding Consensus Conference were published in a consensus agreement defining tumor budding and specifically separated tumor budding from tumor grading. 77 The international group achieved consensus on important statements, including that tumor budding is defined as a single tumor cell or a cell cluster consisting of 4 or fewer tumor cells; tumor budding is an independent predictor of LNM in malignant polyps and should be assessed in addition to other clinicopathologic features in a multidisciplinary setting and be part of the CRC reporting system.…”