Histopathological factors help to predict lymph node metastases more efficiently than extra-nodal recurrences in submucosa invading pT1 colorectal cancer

Abstract

The therapeutic management of patients with endoscopic resection of colorectal cancer invading the submucosa (i.e. pT1 CRC) depends on the balance between the risk of cancer relapse and the risk of surgery-related morbidity and mortality. The aim of our study was to report on the histopathological risk factors predicting lymph node metastases and recurrences in an exhaustive case series comprising every pT1 CRC (of adenocarcinoma subtype only) diagnosed in Finistère (France) during 5-years. For 312 patients with at least 46 months follow-up included in the digestive cancers registry database, histopathological factors required for risk stratification in pT1 CRC were reviewed. Patients were treated by endoscopic resection only (51 cases), surgery only (138 cases), endoscopic resection followed by surgery (102 cases) or transanal resection (21 cases). Lymph node metastases were diagnosed in 19 patients whereas 15 patients had an extra-nodal recurrence (7 local recurrences only, 4 distant metastases only and 4 combining local and distant recurrences). Four patients with distant metastases died of their cancer. Poor tumor differentiation, vascular invasion and high grade tumor budding on HES slides were notably identified as strong risk-factors of lymph node metastases but the prediction of extra-nodal recurrences (local, distant and sometimes fatal) was less obvious, albeit it was more frequent in patients treated by transanal resection than with other treatment strategies. Beyond good performances in predicting lymph node metastases and guiding therapeutic decision in patients with pT1 CRC, our study points that extra-nodal recurrence of cancer is more difficult to predict and requires further investigations.

Management of large polyps in a colorectal cancer screening program with fecal immunochemical test: a population-based study

“…As others, we found that 8.5% of LPs were T1 CRCs (9.3% of them N1) and 15.9% of them were cured by ER (16.3% in a French population-based study (32,34). These rates were significantly lower in pedunculated LPs (6.1%, 5.4% and 37.8%, respectively) than in non-pedunculated LPs (10.8%, 11.4% and 4.3%, respectively).…”

A Liquid Biopsy Assay for Noninvasive Identification of Lymph Node Metastases in T1 Colorectal Cancer

“…Several reports have indicated the potential of ESD for diagnosing LNM in patients with T1 CRC 40,41 ; however, others suggest its diagnostic accuracy for LNM is still inadequate. 42 Because current clinical guidelines consider the presence of LNM an important risk factor for classifying a patient with T1 CRC as high risk, this highlights the need to develop robust biomarkers for LNM before treatment, which would be clinically transformative in selecting patients who truly require such invasive and radical surgical treatments. Our ability to successfully validate our signature in pretreatment serum samples underscores its clinical significance for improved treatment strategies in patients with T1 CRC, especially the ones who truly have LNM.…”

Predicting Tumor Budding Status in Cervical Cancer Using MRI Radiomics: Linking Imaging Biomarkers to Histologic Characteristics

“…Many studies showed that TB status was significantly associated with disease-specific survival in colorectal cancer [16][17][18][19]. In addition, T stage and lymph node metastasis were shown to be related to TB status in colorectal cancer [20]. The prognostic relevance of TB status is well-established in colorectal cancers, which prompted the inclusion of this histopathologic characteristic in the recent WHO classification of colorectal cancer.…”

“…Many studies showed that TB status was significantly associated with disease-specific survival in colorectal cancer [16][17][18][19]. In addition, T stage and lymph node metastasis were shown to be related to TB status in colorectal cancer [20]. Besides its prognostic relevance in colorectal cancer, it has been demonstrated that TB was associated with the prognosis of other cancer types, including esophageal, gastric, pancreatic, breast, and head and neck cancer in meta-analyses [21][22][23][24][25][26].…”