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

Abstract

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.

Influence of Old Age on Risk of Lymph Node Metastasis and Survival in Patients With T1 Colorectal Cancer: A Population-Based Analysis

“…Furthermore, only tumor size ≥ 3 cm showed an elevated risk of regional LNM (OR = 1.316, 95%CI: 1.016-1.706, P = 0.038). Like other studies concerning colorectal cancer [21][22][23], Consistent with our discovered that tumor size was a predictive factor for the risk of LNM in T1 colorectal cancer.…”

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

“…T1 colon cancer, which refers to carcinoma with invasion confined to the submucosa, however, had an approximately 10% probability of experiencing lymph node metastases and therefore requires radical intestinal resection with lymph node dissection. Many studies have previously evaluated the risk factors for lymph node metastasis in T1 colon cancer, however, differences in opinion have always existed (3,5,(17)(18)(19)(20)(21).…”

Development and external validation of a predictive scoring system associated with metastasis of T1‐2 colorectal tumors to lymph nodes

“…At present, the diagnosis of young CRC patients has increased. Relevant research has demonstrated that age was an independent predictive factor of LNM in T1‐2 CRC patients, with younger age associated with more promising outcomes 17,18 . Xu et al 18 .…”

“…Relevant research has demonstrated that age was an independent predictive factor of LNM in T1‐2 CRC patients, with younger age associated with more promising outcomes 17,18 . Xu et al 18 . argued that the risk of LNM in patients aged 65–79 and over 80 years decreased to approximately 0.65 and 0.44, respectively, compared with patients under 49 years old.…”