Management and outcome of patients with invasive carcinoma arising in colorectal polyps

Volk, Emily E.; Goldblum, John R.; Petras, Robert E.; Carey, William D.; Fazio, Victor W.

doi:10.1016/0016-5085(95)90746-7

Cited by 199 publications

(178 citation statements)

References 23 publications

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“…According to previous reports, moderately or poorly differentiated adenocarcinoma 3,7,12,13 , and a bud-like structure 9 in submucosal invasive areas are risk factors for lymph node metastasis. Although our data trends were similar, these factors did not show statistical significance in our study.…”

Section: Discussionmentioning

confidence: 94%

“…Although our data trends were similar, these factors did not show statistical significance in our study. Moreover, many investigators [3][4][5][6][7][8][9][10][11][12][13][14][15] list mucinous adenocarcinoma as a Risk of metastasis of submucosal colon cancer Y Egashira et al risk factor for lymph node metastasis. In this study, mucinous adenocarcinoma was considered as two types, one composed of undifferentiated nontubular carcinoma (signet ring cell carcinoma in the majority) and one composed of differentiated tubular adenocarcinoma.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2004

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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...

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

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

et al. 2004

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“…In 23 series, [14][15][16][17][18][19][20][21][22][24][25][26][27]29,[31][32][33][34][35]38,[40][41][42] clinical or endoscopic follow-up data were available, ranging from 12 to 90 (median, 60) months, and accounting for 1,535 (80.1 percent) of the included polyps. Regarding endoscopic data, polyp site was clearly specified in 17 series, accounting for 1,461 polyps.…”

Section: Descriptive Analysismentioning

confidence: 99%

“…Death because of surgical complications, inferred from 28 studies, was reported in 8 (0.8 percent) of 951 operated patients. [12][13][14][15][16][17][18][19][20][21][24][25][26][27][28][29][30][31][32][33][34][36][37][38][39][40][41][42] …”

Section: Descriptive Analysismentioning

confidence: 99%

“…[12][13][14][16][17][18][19]21,[27][28][29][30][31][32][33][34]37,[40][41][42] According to our protocol, the resection margin was reported to be positive in 325 (33.2 percent) and negative in the remaining 655 (66.8 percent) cases. In those studies for which polyp morphology also could be inferred, a positive resection margin was significantly more frequent in sessile (25/44) than in pedunculated (34/182) polyps (56.8 vs. 18.7 percent; P < 0.0001).…”

Section: Resection Marginmentioning

confidence: 99%

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Histologic Risk Factors and Clinical Outcome in Colorectal Malignant Polyp: A Pooled-Data Analysis

Hassan

Zullo

Risio

et al. 2005

Diseases of the Colon &Amp; Rectum

192

186

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PURPOSE:The malignant polyp carries a significant risk of lymphohematic metastasis and mortality. Clinical usefulness of histologic risk factors is still controversial. The study was designed to compute the association between the main histologic risk factors and the occurrence of unfavorable outcomes in patients with malignant polyps. METHODS: A MEDLINE search regarding malignant polyps was performed. Three histologic risk factors (positive resection margin, poor differentiation of carcinoma, vascular invasion) and five (residual disease, recurrent disease, lymph node metastasis, hematogenous metastasis, mortality) unfavorable clinical outcomes were evaluated. Further analysis was performed by subgrouping polyps in high-risk and lowrisk groups. RESULTS: Thirty-one studies enrolling 1,900 patients with malignant polyp were selected. Positivity of resection margin was significantly predictive of the presence of residual disease (odds ratio, 22; P < 0.0001), poorly differentiated carcinoma was associated with an increased mortality (odds ratio, 9.2; P < 0.05), and vascular invasion with a higher lymph node metastasis risk (odds ratio, 7; P < 0.05). Patients with high-risk polyps showed a significantly worse outcome than those with low-risk, especially for mortality (odds ratio, 11; P < 0.05). Surgical-related death was as low as 0.8 percent. CONCLUSIONS: All three histologic risk factors are significantly associated with the clinical outcome. Classification in low-risk and high-risk patients may be regarded as a meaningful staging procedure. T he malignant polyp, namely an adenoma containing a carcinoma invading the submucosa but not the muscular layer, represents the vast majority of early colorectal cancer, carrying a small but significant risk of both lymphohematic metastasis and mortality. 1

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American Joint Committee on Cancer prognostic factors consensus conference

Compton

Fenoglio‐Preiser

Pettigrew

et al. 2000

Cancer

576

369

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Management and outcome of patients with invasive carcinoma arising in colorectal polyps

Cited by 199 publications

References 23 publications

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

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

Histologic Risk Factors and Clinical Outcome in Colorectal Malignant Polyp: A Pooled-Data Analysis

American Joint Committee on Cancer prognostic factors consensus conference

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