Retrospective analysis of LNM risk factors and the effect of chemotherapy in early colorectal cancer: A Chinese multicenter study

Abstract

Background Estimating the risk of lymph node metastasis (LNM) is crucial for determining subsequent treatments following curative resection of early colorectal cancer (ECC). This multicenter study analyzed the risk factors of LNM and the effectiveness of postoperative chemotherapy in patients with ECC. Methods We retrospectively analyzed the data of 473 patients with ECC who underwent general surgery in five hospitals between January 2007 and October 2018. The correlations between LNM and sex, age, tumor size, tumor location, endoscopic morphology, pathology, depth of invasion and tumor budding (TB) were directly estimated based on postoperative pathological analysis. We also observed the overall survival (OS) and recurrence in ECC patients with and without LNM after matching according to baseline measures. Results In total, 473 ECC patients were observed, 288 patients were enrolled, and 17 patients had LNM (5.90%). The univariate analysis revealed that tumor size, pathology, and lymphovascular invasion were associated with LNM in ECC (P = 0.026, 0.000, and 0.000, respectively), and the multivariate logistic regression confirmed that tumor size, pathology, and lymphovascular invasion were risk factors for LNM (P = 0.021, 0.023, and 0.001, respectively). There were no significant differences in OS and recurrence between the ECC patients with and without LNM after matching based on baseline measures (P = 0.158 and 0.346, respectively), and no significant difference was observed between chemotherapy and no chemotherapy in ECC patients without LNM after surgery (P = 0.729 and 0.052). Conclusion Tumor size, pathology, and lymphovascular invasion are risk factors for predicting LNM in ECC patients. Adjuvant chemotherapy could improve OS and recurrence in patients with LNM but not always in ECC patients without LNM.

A Retrospective Multicenter Study of Risk Factors, Stratification, and Prognosis of Lymph Node Metastasis in T1 and T2 Colorectal Cancer

“…The present study showed that the incidence of LNM among these patients with T1 or T2 cancer was 11.4% (8% in T1 and 16.2% in T2), which is consistent with the rates of 12.7% to 21% reported in previous studies (4.7-17.6% for T1 and 18.0-24.5% for T2) [1,2,7,9,[13][14][15]. LNM is well known as an important risk factor for CRC and is hence included in the assessment of tumor stage [25].…”

“…Many previous studies have investigated tumor location as a predictive factor for LNM. Some studies reported a higher rate of LNM for cancers located in the rectum than those located in the colon [9,11], whereas others did not find an association between tumor location and metastasis [4][5][6]8,10,14]. One possible reason for these discrepancies is that some studies divided the tumor location into three, five, or eight categories [5,6,10,14] instead of two categories (colon and rectum).…”

“…Implementation of population-based screening programs and advances in endoscopic techniques have led to increased numbers of patients being diagnosed with early colorectal cancer (CRC) [3]. Among tumors within the muscularis propria, lymph node metastasis (LNM) was found in 4.7-12.3% of patients with T1 early CRC [4][5][6][7][8][9][10][11][12][13][14], increasing to 18.0-24.3% in patients with T2 cancers [1,2,7,9,15].…”

Colorectal Endoscopic Submucosal Dissection: An Update on Best Practice

“…36 However, the association between depth of invasion and LN metastasis is not as clear as expected, and depth of invasion has low predictive value for LN metastasis. For example, in a study of 473 patients with early colorectal cancer in China from 2007 to 2018, larger tumor size and the presence of lymphovascular invasion were associated with higher risk of LN metastasis; 37 no difference in LN metastasis was observed based on depth of invasion. 37 All guidelines in the last 5 years refer to >1000 μm as an unfavorable risk factor for LN metastasis.…”

“…For example, in a study of 473 patients with early colorectal cancer in China from 2007 to 2018, larger tumor size and the presence of lymphovascular invasion were associated with higher risk of LN metastasis; 37 no difference in LN metastasis was observed based on depth of invasion. 37 All guidelines in the last 5 years refer to >1000 μm as an unfavorable risk factor for LN metastasis. Despite the general acceptability of 1000 μm as the predictive cut off, the depth of invasion associated with LN metastasis varied in the 39 As mentioned earlier, the risk of LN metastasis increases in proportion to the depth of submucosal invasion as determined by Haggitt and Kudo classification methods.…”