Impact of tumor location on lymph node metastasis in T1 colorectal cancer

Aytaç, Erman; Görgün, Emre; Costedio, Meagan; Stocchi, Luca; Remzi, Feza H.; Keßler, Hermann

doi:10.1007/s00423-016-1452-x

Cited by 16 publications

(11 citation statements)

References 22 publications

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“…Notably, the lowest rate of a positive lymph-node status rate was observed in the rectum group. This result did not draw a similar conclusion to that reported by several other studies that found a more frequent occurrence of LNM in the rectum [ 28 , 29 ]. The patient cohorts of previous retrospective studies were small and included more tumors in the lower third of the rectum, which is the possible reason for this discrepancy.…”

Section: Discussioncontrasting

confidence: 87%

Predictors of lymph-node metastasis in surgically resected T1 colorectal cancer in Western populations

Zong

et al. 2021

Gastroenterology Report

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Background The risk of lymph-node metastasis (LNM) in T1 colorectal cancer (CRC) has not been well documented in heterogeneous Western populations. This study investigated the predictors of LNM and the long-term outcomes of patients by analysing T1 CRC surgical specimens and patients’ demographic data. Methods Patients with surgically resected T1 CRC between 2004 and 2014 were identified from the Surveillance, Epidemiology, and End Results (SEER) database. Patients with multiple primary cancers, with neoadjuvant therapy, or without a confirmed histopathological diagnosis were excluded. Multivariate logistic-regression analysis was used to identify the predictors of LNM. Results Of the 22,319 patients, 10.6% had a positive lymph-node status based on the final pathology (nodal category: N1 9.6%, N2 1.0%). Younger age, female sex, Asian or African-American ethnicity, poor differentiation, and tumor site outside the rectum were significantly associated with LNM. Subgroup analyses for patients stratified by tumor site suggested that the rate of positive lymph-node status was the lowest in the rectum (hazard ratio: 0.74; 95% confidence interval: 0.63–0.86). Conclusion The risk of LNM was potentially lower in Caucasian patients than in API or African-American patients with surgically resected T1 CRC. Regarding the T1 CRC site, the rectum was associated with a lower risk of LNM.

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Section: Discussioncontrasting

confidence: 87%

Predictors of lymph-node metastasis in surgically resected T1 colorectal cancer in Western populations

Zong

et al. 2021

Gastroenterology Report

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“…hormones between male and female patients (27,28). It has also been observed that T1 carcinoma located in the left-sided colon shows higher rates of lymph node metastasis than right-sided colon, though it was not statistically significant in our study (29,30). According to current clinical guidelines, T1 colon cancer patients with lymph node metastasis should receive adjuvant chemotherapy following radical surgery.…”

Section: Discussioncontrasting

confidence: 50%

Association Between Chemotherapy and Survival in T1 Colon Cancer With Lymph Node Metastasis: A Propensity-Score Matched Analysis

et al. 2021

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This study aimed to comprehensively examine the efficacy of chemotherapy in T1 colon cancer patients with lymph node metastasis.MethodsThe differences in categorical variables in colon cancer patients according to lymph node status were evaluated by Pearson’s chi-square test. The Kaplan-Meier method was used to assess Cancer-specific survival (CSS) and overall survival (OS) with the log-rank test. Cox proportional hazards models were built, multivariate Cox regression analyses were performed with the hazard ratio (HR) and 95% confidence interval (CI) to identify the potential independent prognostic factors. Propensity score matching was also undertaken to adjust for treatment bias due to measured confounders.ResultsYounger age (52.2% VS. 43.0% for ≤ 65 years old, p < 0.001), female gender (50.3% VS. 46.8% for female, p < 0.001), more lymph nodes harvested (68.1% VS. 46.6% for ≥12 lymph nodes harvested, p < 0.001), Black race (13.6% VS. 12.0% for the Black race, p < 0.001), and higher tumor grade (14.2% VS. 5.6% for grade III/IV, p < 0.001) were more prone to be diagnosed with lymph node involvement. The receipt of adjuvant chemotherapy following radical surgery significantly reduced the risk of colon cancer-specific mortality by 33.9% after propensity-score matching (HR = 0.661, 95%CI = 0.476-0.917, p = 0.013).ConclusionsYounger age, female gender, more lymph nodes harvested, Black race, and higher tumor grade were more prone to be diagnosed with lymph node involvement. The receipt of adjuvant chemotherapy following radical surgery also significantly decreased the risk of colon cancer-specific mortality by 33.9% in T1 colon cancer with lymph node involvement.

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“…Primary tumor location has long been reported to have an impact on the risk of LNM in colorectal cancer [4,23]. The LNM risk in T1 rectal carcinoma has been revealed to be as high as 15% [4,5,24], dropping to 8% in the left colon and 3% in the right colon [4].…”

Section: Discussionmentioning

confidence: 99%

Population-based analysis on predictors for lymph node metastasis in T1 colon cancer

Zhang

et al. 2019

Surg Endosc

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Background In this study, we aimed to identify independent predictive factors for lymph node metastasis (LNM) in T1 colon cancer. Methods Data of 8056 eligible patients were retrospectively collected from the Surveillance, Epidemiology, and End Results (SEER) database during 2004-2012. We performed logistic regression analysis to identify predictive factors for LNM. Both unadjusted and adjusted Cox regression analyses were used to determine the association between LNM and patient survival. Finally, we used competing risks analysis and the cumulative incidence function (CIF) to further confirm the prognostic role of LNM in cancer-specific survival (CSS). Results The overall risk of LNM in patients with T1 colon cancer was 12.0% (N = 967). Adjusted logistic regression models revealed that mucinous carcinoma [odds ratio (OR) = 2.26, P < 0.001], moderately differentiated (OR 1.74, P < 0.001), poorly differentiated (OR 5.16, P < 0.001), and undifferentiated carcinoma (OR 3.01, P = 0.003); older age (OR 0.66, P < 0.001 for age 65-79 years, OR 0.44, P < 0.001 for age over 80 years); and carcinoma located in the ascending colon (OR 0.77, P = 0.018) and sigmoid colon (OR 1.24, P = 0.014) were independent predictive factors for LNM. Adjusted Cox regression analysis showed that positive lymph node involvement was significantly associated with CSS [hazard ratio (HR) = 3.02, P < 0.001], which was further robustly confirmed using a competing risks model and the CIF. Conclusions This population-based study showed that mucinous carcinoma, tumor grade, age, and primary tumor location were independent predictive factors for LNM in T1 colon cancer. The risk of LNM should be carefully evaluated in patients with T1 colon cancer, before clinical management. Keywords Colon cancer • Lymph node metastasis • Independent predictive factors • SEER database Colorectal cancer is among the leading causes of cancerrelated mortality in both western countries and China [1, 2]. Colorectal cancer is mainly divided into colon cancer and rectal cancer based on primary tumor location, with colon cancer accounting for approximately 70% of colorectal cancers [1, 3]. Early colon cancer refers to carcinoma with invasion limited to the submucosa [4, 5], which can be designated T1N X M0 based on the TNM classification system.

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Impact of tumor location on lymph node metastasis in T1 colorectal cancer

Abstract: Although it was not statistically significant, lymph node positivity varies based on tumor location of T1 colorectal adenocarcinoma regardless of fundamental tumor characteristics including size, differentiation, and lymphovascular invasion.

Cited by 16 publications

References 22 publications

Predictors of lymph-node metastasis in surgically resected T1 colorectal cancer in Western populations

Predictors of lymph-node metastasis in surgically resected T1 colorectal cancer in Western populations

Association Between Chemotherapy and Survival in T1 Colon Cancer With Lymph Node Metastasis: A Propensity-Score Matched Analysis

Population-based analysis on predictors for lymph node metastasis in T1 colon cancer

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