Pathologic predictive factors for lymph node metastasis in submucosal invasive (T1) colorectal cancer: a systematic review and meta-analysis

Abstract

Well-differentiated nonpedunculated T1 colorectal cancer invasive into the submucosa ≤1,000 μm, without lymphovascular involvement or tumor budding, has the lowest risk of nodal metastasis. Importantly, the risk was not zero (1.9 %), and the qualitative formal analysis of data was not strong. As such, endoscopic resection alone may be adequate in select patients with submucosal invasive colorectal cancers, but more studies are needed. Overall, the quality of evidence was poor; data were from small retrospective studies from limited geographic regions.

Systematic review and meta-analysis of histopathological predictive factors for lymph node metastasis in T1 colorectal cancer

“…Comparison with other studies To our knowledge, only two systematic reviews have been published previously on histopathological factors influencing the risk of lymph node metastasis in colorectal cancer, and these identified reliable histopathological risk factors in small and retrospective studies [12,13]. The authors of these two meta-analyses came to almost the same conclusion, namely, that depth of submucosal invasion of [1 mm, LVI, poorly differentiated tumor, and tumor budding were all risk factors.…”

“…Many studies on histopathological predictive factors for lymph node metastasis in T1 colorectal cancer have been conducted, and various risk factors have been identified [2][3][4][5][7][8][9][10][11]. Although most of these studies are small and retrospective, to our knowledge only two systematic reviews on histopathological predictive factors for lymph node metastasis in T1 colorectal cancer have been published to date [12,13]. The authors of these meta-analyses drew similar conclusions, namely, lymph node metastasis in T1 colorectal cancer is significantly associated with (1) depth of submucosal invasion by the primary tumor of [1 mm, (2) lymphovascular invasion, (3) poor differentiation, and (4) tumor budding.…”

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

“…As LNM is difficult to assess preoperatively, the decision to perform radical surgery following endoscopic resection is based on the results of clinicopathological analysis. Several previous systematic reviews of small, retrospective studies have identified reliable pathological factors associated with the risk of LNM in T1 colorectal cancer (13)(14)(15)(16)(17). These meta-analyses reported that depth of submucosal invasion >1,000 µm, lymphovascular invasion, poorly differentiated tumors and tumor budding were all risk factors for LNM.…”

“…Other studies also reported higher rates of LNM in female compared with male patients, although these differences were not statistically significant (11,12). Several systematic reviews and meta-analyses have investigated risk factors for LNM; however, none has focused on patient gender as a predictive factor for LNM to date (13)(14)(15)(16)(17). The aim of the present systematic review and meta-analysis was to assess whether the gender of patients with T1 colorectal cancer is predictive of LNM.…”

‘Head Invasion' Is Not a Metastasis-Free Condition in Pedunculated T1 Colorectal Carcinomas Based on the Precise Histopathological Assessment

“…Complete endoscopic resection of intramucosal carcinoma is accepted as curative because there is no risk of lymph node metastasis (LNM) [2,3] . In contrast, approximately 10% of T1CC cases are associated with LNM; therefore, the resected specimen must be examined to determine whether there is a clini-cally significant risk of LNM that would warrant additional surgery [4][5][6][7][8][9][10][11] . Previously, histopathological factors such as the degree of submucosal invasion, lymphovascular infiltration, poor differentiation, and tumor budding were reported to be associated with LNM [6,[12][13][14][15][16][17][18] .…”