Analysis of pathological risk factors for lymph node metastasis of submucosal invasive colon cancer

Abstract

There are currently no universally accepted indications and criteria for additional surgical resection of the colorectum after endoscopic resection of the submucosal invasive cancer. The purpose of the present study is to establish accurate indications and criteria for additional surgical resection of the colorectum, based on the prediction of lymph node metastasis, after endoscopic resection of the submucosal invasive cancer. We investigated 140 submucosal invasive colorectal cancers and analyzed the pathologic factors of lymph node metastasis. The tumors were evaluated for pathologic factors in the invasive area of the submucosal carcinoma and were compared between the cases with lymph node metastasis and those without lymph node metastasis. Lymph node metastasis was observed in 13 cases (9%). Univariate logistic regression analysis showed that the depth of invasion, cribriform-type structural atypia, absence of lymphoid infiltration, lymphatic permeation, and venous permeation were statistically significant as risk factors for lymph node metastasis. Multivariate logistic regression analysis showed that the important risk factors included, in decreasing order, lymphatic permeation, absence of lymphoid infiltration, cribriform-type structural atypia, venous permeation, and depth of invasion. Submucosal invasion of 2 mm or more, and/or, depth of lymphatic permeation of 2 mm or more are risk factors for lymph node metastasis. The pathologic criteria based on our results for additional colectomy enables greater accuracy selection of patients who will undergo further surgical treatment after endoscopic resection. Keywords: colorectal cancer; submucosal invasive cancer; criteria for additional colectomy; risk factor of lymph node metastasis Endoscopic resection has become the established standard treatment for mucosal carcinoma and adenoma of the colon. Submucosal invasive cancer may not be diagnosed, in some cases, until after endoscopic resection. Thus, pathologists are increasingly encountering submucosal invasive colorectal carcinomas, which are endoscopically resected. Since 10% or less of cases of submucosal invasive cancer had metastasized to the lymph nodes according to previous reports, 1-7 additional surgical resection of the colorectum after endoscopic resection of submucosal invasive cancer is needed for curative treatment. However, there are currently no universally accepted indications and criteria for additional surgical resection of the colorectum after endoscopic resection of submucosal invasive cancer. As a result, many cases (the remainder, except cases with lymph node metastasis, ie, about 90% of the total cases) involving additional surgical resection of the colorectum constitute overtreatment. Establishment of accurate criteria for additional surgical resection of the colorectum, based on the prediction of lymph node metastasis, after endoscopic resection of submucosal invasive cancer is more than necessary. Thus, toward this goal, we investigated and analyzed the pathologic factors of lymph no...

Pathological prognostic factors predicting lymph node metastasis in submucosal invasive (T1) colorectal carcinoma

“…Many investigators have reported that submucosal invasion depth is a risk factor for lymph node metastasis. [1][2][3][4][5][6][7] However, problems exist with measurement of the depth of submucosal invasion when the muscularis mucosa is completely disrupted by tumor invasion. In such cases, measured submucosal invasion depths might be inconsistent.…”

“…Most previous reports have analyzed only small numbers of dissected lymph nodes: 7.3±4.9 lymph nodes in the study by Nascimbeni et al, 3 and a median number of 10 in the study by Okabe et al, 5 whereas the number of removed lymph nodes was not described in several other reports. 4,6,7 Wang et al 12 showed that the total number of sampled lymph nodes was associated with the prognosis of submucosal invasive colorectal carcinoma. Therefore, accurate diagnosis of lymph node status by retrieving a sufficient number of nodes is essential for examining the relationship between clinicopathological factors and lymph node metastasis.…”

“…[1][2][3][4][5][6][7] Consequently, mucosal colorectal carcinoma is generally treated by endoscopic mucosal resection. [1][2][3][4][5][6][7] Because radical colectomy with lymph node dissection is an invasive treatment, patients with submucosal invasive colorectal carcinoma without lymph node metastasis should be treated by endoscopic mucosal resection, if possible. However, few reports have proposed definite histopathological criteria for additional treatment after endoscopic mucosal resection in patients with submucosal invasive colorectal carcinoma.…”

“…However, few reports have proposed definite histopathological criteria for additional treatment after endoscopic mucosal resection in patients with submucosal invasive colorectal carcinoma. 4,7 Many investigators have reported that lymphatic invasion, venous invasion, tumor differentiation, and the degree of submucosal invasion depth are risk factors of lymph node metastasis. [1][2][3][4][5][6][7] Haggitt et al 1 proposed a four-level classification system for pedunculated lesions with invasive carcinoma based on the depth of invasion, and considered that level 4 invasion, which means invasion of carcinoma into the submucosa to a level deeper than the stalk, to be an important clinical prognostic factor for lymph node metastasis.…”

Pathology of Staging of Early Colorectal Lesions During Surveillance Programmes

“…In one of the studies, all the cases were all initially treated by surgical resection (Egashira et al, 2004). Masaki et al (Masaki et al, 2001b) showed that expression of MMP-7 (a matrix metalloproteinase) at the invasive margin of T1 cancers was significantly associated with other poor histological features and unfavourable outcome.…”