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

Abstract

Abstract. Approximately 10% of patients with T1 colorectal cancer have lymph node metastases (LNM), requiring node dissection along with surgical resection. Patient gender was recently reported to affect the occurrence of LNM. The aim of the present study was to assess whether patient gender was predictive of LNM in T1 colorectal cancer. Public databases, including PubMed, EMBASE and the Cochrane Central Register of Controlled Trials were searched, using key terms related to 'T1 colorectal cancer' and 'lymph node'. All relevant studies reporting the adjusted odds ratio or risk ratio of LNM in relation to patient gender were included. The quality of the studies was classified according to the Quality in Prognostic Studies tool. A random-effects model was used and the quality of the evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation approach. The initial database search identified 2,492 publications; of those, 36 studies reported unadjusted results. Of the 36 studies, 4 reported adjusted results and fulfilled the inclusion criteria for this meta-analysis: 3 studies were graded as having a moderate risk of bias, and 1 had a low risk of bias.The present meta-analysis demonstrated that female gender was associated with increased risk of LNM (risk ratio=2.45, 95% confidence interval: 1.03-3.88). The I 2 statistic was 0.901, classified as very low (+OOO) and was downgraded by the risk of bias, inconsistency and publication bias. In conclusion, female gender was found to be correlated with LNM in patients with T1 colorectal cancer. IntroductionColorectal cancer is one of the most common types of cancer worldwide. Due to the advances in endoscopic treatment, particularly endoscopic submucosal dissection, several T1 colorectal cancers are resected endoscopically with negative margins (1-3). Lymph node metastasis (LNM) occurs in ~10% of patients with T1 colorectal cancer, with these patients requiring surgical resection with lymph node dissection (4-7). Therefore, determining risk factors associated with LNM in patients with T1 colorectal cancer is crucial.A number of studies have assessed factors predictive of LNM in patients with T1 colorectal cancer. Previously identified risk factors for LNM include lymphovascular invasion, histological grade, tumor budding and degree of submucosal invasion (8-10). These factors are included in various diagnostic and treatment guidelines, including those of the National Comprehensive Cancer Network, the European Society for Medical Oncology and the Japanese Society for Cancer of the Colon and Rectum (8-10). However, the majority of the studies identifying these guidelines were retrospective in design and included small numbers of patients. In addition, these analyses were limited to pathological factors. The indications for additional surgery plus lymph node dissection following endoscopic resection remain unclear.A recent retrospective, single-center study, which included a large number of patients, reported that female gender was associ...

Artificial intelligence may help in predicting the need for additional surgery after endoscopic resection of T1 colorectal cancer

“…Of these, tumor budding, lymphatic invasion, vascular invasion, and histological feature were previously reported factors in the guidelines [6 -10]. Patient sex was recently reported to be a risk factor of LNM but is controversial [3,24]. On the other hand, total bilirubin level, weight, and age were novel factors, which were newly identified as important by the artificial intelligence model.…”

Nomogram based on homogeneous and heterogeneous associated factors for predicting distant metastases in patients with colorectal cancer

“…In contrast, males had a higher incidence of left colon cancer. Although some studies indicated sex and gender differences in colorectal cancer development [ 21 , 22 ], the reasons for this difference are not clear. The biological and pathophysiological differences in CRC distant metastasis development between males and females must also be addressed in the future.…”

Left-sided location is a risk factor for lymph node metastasis of T1 colorectal cancer: a single-center retrospective study

“…Furthermore, in Europe and Japan, the degree of SM invasion and in Japan, budding grade are described as risk factors. In addition, female sex and the status of the muscularis mucosae were also reported as risk factors [ 22 , 31 – 33 ]. Regarding location, there have been several reports comparing the rectum and colon, which showed that the rate of LNM was equivalent or higher in the rectum [ 15 , 16 ].…”