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

Abstract

Purpose Although some studies have reported differences in clinicopathological features between left- and right-sided advanced colorectal cancer (CRC), there are few reports regarding early-stage disease. In this study, we aimed to compare the clinicopathological features of left- and right-sided T1 CRC. Methods Subjects were 1142 cases with T1 CRC undergoing surgical or endoscopic resection between 2001 and 2018 at Showa University Northern Yokohama Hospital. Of these, 776 cases were left-sided (descending colon to rectum) and 366 cases were right-sided (cecum to transverse colon). We compared clinical (patients age, sex, tumor size, morphology, initial treatment) and pathological features (invasion depth, histological grade, lymphatic invasion, vascular invasion, tumor budding) including lymph node metastasis (LNM). Results Left-sided T1 CRC showed significantly higher rates of LNM (left-sided 12.0% vs. right-sided 5.4%, P < 0.05) and lymphatic invasion (left-sided 32.7% vs. right-sided 23.2%, P < 0.05). Especially, the sigmoid colon and rectum showed higher rates of LNM (12.4% and 12.1%, respectively) than other locations. Patients with left-sided T1 CRC were younger than those with right-sided T1 CRC (64.9 years ±11.5 years vs. 68.7 ± 11.6 years, P < 0.05), as well as significantly lower rates of poorly differentiated carcinoma/mucinous carcinoma than right-sided T1 CRC (11.6% vs. 16.1%, P < 0.05). Conclusion Left-sided T1 CRC, especially in the sigmoid colon and rectum, exhibited higher rates of LNM than right-sided T1 CRC, followed by higher rates of lymphatic invasion. These results suggest that tumor location should be considered in decisions regarding additional surgery after endoscopic resection. Trial registration This study was registered with the University Hospital Medical Network Clinical Trials Registry (UMIN 000032733).

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

“…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.…”

Tumor Location as a Prognostic Factor in T1 Colorectal Cancer

“…Several studies reported a higher rate of LNM in leftsided cancer patients than in right-sided cancer patients with T1 CRC (Table 2) [9,[26][27][28]. Papers published in 2020-2021 compared the rate of LNM between right-and left-sided colon patients [26][27][28], and the conclusions were the same for all.…”

“…Several studies reported a higher rate of LNM in leftsided cancer patients than in right-sided cancer patients with T1 CRC (Table 2) [9,[26][27][28]. Papers published in 2020-2021 compared the rate of LNM between right-and left-sided colon patients [26][27][28], and the conclusions were the same for all. Ouchi et al investigated the rate of LNM in 458 T1 CRC patients and showed that those with right-sided colon cancer had a lower rate of LNM than patients with left-sided CRC (6/126 [4.8%] vs. 36/332 [10.8%], p = 0.04) [28].…”

“…The authors referred to genetic and anatomical characteristics as potential reasons for such differences. Mochizuki et al also reported that left-sided T1 cancer patients showed significantly higher rates of LNM than those with right-sided cancer (left-sided 63/527 [12.0%] vs. right-sided 12/218 [5.5%], p < 0.05) in a retrospective single-center study investigating 745 T1 CRC patients [26]. They speculated that this difference was owing to the frequency of occurrence of lymphatic invasion, which was the most reliable predictor for LNM, was significantly higher in left-sided cancer patients than in those with right-sided cancer (left-sided 32.7% vs. rightsided 23.2%, p < 0.05), although the mechanism was un- [29].…”

Risk Stratification of T1 Colorectal Cancer Metastasis to Lymph Nodes: Current Status and Perspective

“…They concluded that rectum was a risk factor for LNM (rectum 13.8% vs colon 9.9%: relative risk, 1.4; 95% confidence interval [CI], 1.1 to 1.7; p<0.001). Several studies have divided tumor location into left-and right-sided CRCs, 19,[38][39][40] all of which concluded that left-sided T1 CRCs (10.8% to 12.0%) showed a significantly higher rate of LNM than right-sided tumors (4.8% to 5.4%). Genetic or anatomical features may affect these differences.…”