Risk factors and predictors of lymph nodes metastasis and distant metastasis in newly diagnosed T1 colorectal cancer

Abstract

Background Lymph nodes metastasis (LNM) and distant metastasis (DM) are important prognostic factors in colorectal cancer (CRC) and determine the following treatment approaches. We aimed to find clinicopathological factors associated with LNM and DM, and analyze the prognosis of CRC patients with T1 stage. Methods A total of 17 516 eligible patients with T1 CRC were retrospectively enrolled in the study based on the Surveillance, Epidemiology, and End Results (SEER) database during 2004‐2016. Logistic regression analysis was performed to identify risk factors for LNM and DM. Unadjusted and adjusted Cox proportional hazard models were used to identify prognostic factors for overall survival. We performed the cumulative incidence function (CIF) to further determine the prognostic role of LNM and DM in colorectal cancer‐specific death (CCSD). LNM, DM, and OS nomogram were constructed based on these models and evaluated by the C‐index and calibration plots for discrimination and accuracy, respectively. The clinical utility of the nomograms was measured by decision curve analyses (DCAs) and subgroups with different risk scores. Results Tumor grade, mucinous adenocarcinoma, and age accounted for the first three largest proportion among the LNM nomogram scores (all, P < .001), whereas N stage, carcinoembryonic antigen (CEA), and tumor size occupied the largest percentage in DM nomogram (all, P < .001). OS nomogram was formulated to visually to predict 3‐, 5‐, and 10‐ year overall survivals for patients with T1 CRC. The calibration curves showed an effectively predictive accuracy of prediction nomograms, of which the C‐index were 0.666, 0.874, and 0.760 for good discrimination, respectively. DCAs and risk subgroups revealed the clinical effectiveness of these nomograms. Conclusions Novel population‐based nomograms for T1 CRC patients could objectively and accurately predict the risk of LNM and DM, as well as OS for different stages. These predictive tools may help clinicians to make individual clinical decisions, before clinical management.

Predictive Nomogram and Risk Factors for Lymph Node Metastasis in Bladder Cancer

“…Nomograms can also present simple statistical analysis and visualization results, which are helpful for clinical decisionmaking and for promoting the development of personalized medical therapy. Recently, nomograms have been broadly applied to predict the risk of LNM in different tumors and have been proven to be effective (21)(22)(23).…”

Risk factors and predictors for tumor site origin in metastatic adenocarcinoma of unknown primary site

“…External validation was exhibited by calibration curves using the validation set. Moreover, we performed decision curve analysis (DCA) 13 to reveal the clinical utility of the nomograms by calculating the net benefits at each threshold probability, while clinical impact curves (CIC) 14 were conducted to help us understand the models’ clinical value more intuitively.…”

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

“…Table 2 presents risk factors for LNM from multivariate analyses of studies with more than 400 cases of T1 CRC. 14,[17][18][19][20][21][25][26][27][28] Studies using the same database in the Surveillance, Epidemiology, and End Results (SEER) included one with a longer study period. 19,29 As mentioned in each guideline, lymphovascular invasion (odds ratio [OR], 4.4 to 10.199), histological differentiation (OR, 2.09 to 18.444), tumor budding (OR, 1.70 to 2.350), and depth of submucosal invasion (OR, 2.14 to 5.404) were reported in many studies to be the main risk factors for LNM in T1 CRCs.…”

“…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.…”

“…[6][7][8][9][10][11][12][13] However, even following these guidelines, LNM occurs in only 6% to 16% of such patients. [14][15][16][17][18][19][20][21][22][23] Most patients without LNM are routinely exposed to the risk of surgical resection with an associated postoperative mortality rate of 1.5% to 2% and no clinical benefit. 24 To reduce these unnecessary surgical resections and provide patients with proper treatment without excess or deficiency, development of a more accurate prediction model for LNM is necessary.…”