Meta-analysis of Predictive Clinicopathologic Factors for Lymph Node Metastasis in Patients with Early Colorectal Carcinoma

Choi, Ju Young; Jung, Sung Ae; Shim, Ki Nam; Cho, Won Young; Keum, Bora; Byeon, Jeong Sik; Huh, Kyu Chan; Jang, Byung Ik; Chang, Dong Kyung; Jung, Hwoon Yong; Kong, Kyoung Ae

doi:10.3346/jkms.2015.30.4.398

Cited by 82 publications

(83 citation statements)

References 35 publications

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“…Kitajima et al reported that the rate of LNM was 0% if the depth was < 1000 µm . Another review showed the depth of ≥ 1000 µm was a risk factor of LNM . In this study, however, the invasion depth turned out not to be significant, because five lesions developed LNM among 61 cases with < 1000 µm.…”

Section: Discussioncontrasting

confidence: 59%

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Management of T1 colorectal cancers after endoscopic treatment based on the risk stratification of lymph node metastasis

Miyachi

Kudo

Ichimasa

et al. 2016

J of Gastro and Hepatol

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Background and Aim: Recent advances in endoscopic technology have allowed many T1 colorectal carcinomas to be resected endoscopically with negative margins. However, the criteria for curative endoscopic resection remain unclear. We aimed to identify risk factors for nodal metastasis in T1 carcinoma patients and hence establish the indication for additional surgery with lymph node dissection. Methods: Initial or additional surgery with nodal dissection was performed in 653 T1 carcinoma cases. Clinicopathological factors were retrospectively analyzed with respect to nodal metastasis. The status of the muscularis mucosae (MM grade) was defined as grade 1 (maintenance) or grade 2 (fragmentation or disappearance). The lesions were then stratified based on the risk of nodal metastasis. Results: Muscularis mucosae grade was associated with nodal metastasis (P = 0.026), and no patients with MM grade 1 lesions had nodal metastasis. Significant risk factors for nodal metastasis in patients with MM grade 2 lesions were attribution of women (P = 0.006), lymphovascular infiltration (P < 0.001), tumor budding (P = 0.045), and poorly differentiated adenocarcinoma or mucinous carcinoma (P = 0.007). Nodal metastasis occurred in 1.06% of lesions without any of these pathological factors, but in 10.3% and 20.1% of lesions with at least one factor in male and female patients, respectively. There was good inter-observer agreement for MM grade evaluation, with a kappa value of 0.67. Conclusions: Stratification using MM grade, pathological factors, and patient sex provided more appropriate indication for additional surgery with lymph node dissection after endoscopic treatment for T1 colorectal carcinomas.

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Section: Discussioncontrasting

confidence: 59%

“…31 Another review showed the depth of ≥ 1000 μm was a risk factor of LNM. 32 In this study, however, the invasion depth turned out not to be significant, because five lesions developed LNM among 61 cases with < 1000 μm. It does not mean that this result lacks in consistency with, for example, the following cases.…”

Section: Discussioncontrasting

confidence: 57%

Management of T1 colorectal cancers after endoscopic treatment based on the risk stratification of lymph node metastasis

Miyachi

Kudo

Ichimasa

et al. 2016

J of Gastro and Hepatol

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“…Other studies also reported higher rates of LNM in female compared with male patients, although these differences were not statistically significant (11,12). Several systematic reviews and meta-analyses have investigated risk factors for LNM; however, none has focused on patient gender as a predictive factor for LNM to date (13)(14)(15)(16)(17). The aim of the present systematic review and meta-analysis was to assess whether the gender of patients with T1 colorectal cancer is predictive of LNM.…”

Section: Introductionmentioning

confidence: 80%

“…As LNM is difficult to assess preoperatively, the decision to perform radical surgery following endoscopic resection is based on the results of clinicopathological analysis. Several previous systematic reviews of small, retrospective studies have identified reliable pathological factors associated with the risk of LNM in T1 colorectal cancer (13)(14)(15)(16)(17). These meta-analyses reported that depth of submucosal invasion >1,000 µm, lymphovascular invasion, poorly differentiated tumors and tumor budding were all risk factors for LNM.…”

Section: Discussionmentioning

confidence: 99%

Patient gender as a factor associated with lymph node metastasis in T1 colorectal cancer: A systematic review and meta-analysis

Ichimasa

Kudo

Miyachi

et al. 2017

Molecular and Clinical Oncology

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Abstract. Approximately 10% of patients with T1 colorectal cancer have lymph node metastases (LNM), requiring node dissection along with surgical resection. Patient gender was recently reported to affect the occurrence of LNM. The aim of the present study was to assess whether patient gender was predictive of LNM in T1 colorectal cancer. Public databases, including PubMed, EMBASE and the Cochrane Central Register of Controlled Trials were searched, using key terms related to 'T1 colorectal cancer' and 'lymph node'. All relevant studies reporting the adjusted odds ratio or risk ratio of LNM in relation to patient gender were included. The quality of the studies was classified according to the Quality in Prognostic Studies tool. A random-effects model was used and the quality of the evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation approach. The initial database search identified 2,492 publications; of those, 36 studies reported unadjusted results. Of the 36 studies, 4 reported adjusted results and fulfilled the inclusion criteria for this meta-analysis: 3 studies were graded as having a moderate risk of bias, and 1 had a low risk of bias.The present meta-analysis demonstrated that female gender was associated with increased risk of LNM (risk ratio=2.45, 95% confidence interval: 1.03-3.88). The I 2 statistic was 0.901, classified as very low (+OOO) and was downgraded by the risk of bias, inconsistency and publication bias. In conclusion, female gender was found to be correlated with LNM in patients with T1 colorectal cancer. IntroductionColorectal cancer is one of the most common types of cancer worldwide. Due to the advances in endoscopic treatment, particularly endoscopic submucosal dissection, several T1 colorectal cancers are resected endoscopically with negative margins (1-3). Lymph node metastasis (LNM) occurs in ~10% of patients with T1 colorectal cancer, with these patients requiring surgical resection with lymph node dissection (4-7). Therefore, determining risk factors associated with LNM in patients with T1 colorectal cancer is crucial.A number of studies have assessed factors predictive of LNM in patients with T1 colorectal cancer. Previously identified risk factors for LNM include lymphovascular invasion, histological grade, tumor budding and degree of submucosal invasion (8-10). These factors are included in various diagnostic and treatment guidelines, including those of the National Comprehensive Cancer Network, the European Society for Medical Oncology and the Japanese Society for Cancer of the Colon and Rectum (8-10). However, the majority of the studies identifying these guidelines were retrospective in design and included small numbers of patients. In addition, these analyses were limited to pathological factors. The indications for additional surgery plus lymph node dissection following endoscopic resection remain unclear.A recent retrospective, single-center study, which included a large number of patients, reported that female gender was associ...

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“…Aiding the accurate histopathologic diagnosis of specimens is one of the primary reasons for recommending ESD in guidelines from both Japan and Europe, and the types of lesion where this is particularly recommended will be discussed in further detail below 20,35,37. In addition, en bloc resection allows curative endoscopic resection of adenocarcinoma with early submucosal invasion, as lymph node metastases are rare in adenocarcinoma with only superficial submucosal invasion or invading <1000 µm from the muscularis mucosae 38,39. In fact, several series have demonstrated that, in the absence of high-risk histopathologic factors including lymphovascular invasion, poor differentiation or tumor budding, early colorectal cancer with only superficial submucosal invasion or invasion to a depth of <1000 µm is associated with a risk of lymph node metastases approaching 0% 40–46.…”

Section: Introductionmentioning

confidence: 99%

Colorectal endoscopic submucosal dissection: patient selection and special considerations

Emmanuel¹,

Gulati²,

Burt³

et al. 2017

CEG

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Endoscopic submucosal dissection (ESD) enables en bloc resection of large complex colorectal superficial neoplastic lesions, resulting in very low rates of local recurrence, high-quality pathologic specimens for accurate histopathologic diagnosis and potentially curative treatment of early adenocarcinoma without resorting to major surgical resection. The safety and efficacy of the technique, which was pioneered in the upper gastrointestinal tract, has been established by the consistently impressive outcomes from expert centers in Japan and some other eastern countries. However, ESD is challenging to perform in the colorectum and there is a significant risk of complications, particularly in the early stages of the learning curve. Early studies from western centers raised concerns about the high complication rates, and the impressive results from Japanese centers were not replicated. As a result, many western endoscopists are skeptical about the role of ESD and few centers have incorporated the technique into their practice. Nevertheless, although the distribution of expertise, referral centers and modes of practice may differ in Japan and western countries, ESD has an important role and can be safely and effectively incorporated into western practice. Key to achieving this is meticulous lesion assessment and selection, appropriate referral to centers with the necessary expertise and experience and application of the appropriate technique individualized to the patient. This review discusses the advantages, risks and benefits of ESD to treat colorectal lesions and the importance of preprocedure lesion assessment and in vivo diagnosis and outlines a pragmatic rationale for appropriate lesion selection as well as the patient, technical and institutional factors that should be considered.

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Meta-analysis of Predictive Clinicopathologic Factors for Lymph Node Metastasis in Patients with Early Colorectal Carcinoma

Cited by 82 publications

References 35 publications

Management of T1 colorectal cancers after endoscopic treatment based on the risk stratification of lymph node metastasis

Management of T1 colorectal cancers after endoscopic treatment based on the risk stratification of lymph node metastasis

Patient gender as a factor associated with lymph node metastasis in T1 colorectal cancer: A systematic review and meta-analysis

Colorectal endoscopic submucosal dissection: patient selection and special considerations

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