Risk Factors for Lymph Node Metastasis and Recurrence in T1 Colorectal Cancer: Analysis of 801 Patients in a Single Institute

Abstract

Objective To identify risk factors for lymph node metastasis and postoperative recurrence of pT1 colorectal cancer by clinicopathological study of surgically resected cases. Methods In 801 patients with pT1 colorectal cancer who underwent surgical resection with lymph node dissection between April 2007 and January 2021, we evaluated clinicopathological factors (age, gender, BMI, serum CEA level, tumor localization, additional resection after endoscopic treatment, operation time, blood loss, histological type, tumor size, vascular invasion, and central lymph node dissection). We performed univariate and multivariate analyses to examine risk factors for lymph node metastasis. We also examined risk factors for recurrence in 583 patients up to December 2017. Results Lymph node metastasis was observed in 100/801 patients (12.5%). Multivariate analysis of lymph node metastasis showed that patients with positive lymphatic invasion (odds ratio 2.57, 95% CI 1.62-4.04, P < .0001), positive venous invasion (odds ratio 2.31, 95% CI 1.48-3.61, P = .0002), and histologically poorly differentiated type (odds ratio 4.54, 95% CI 1.35-15.2, P = .014) were identified as risk factors. Postoperative recurrence was observed in 18/580 patients (3.1%). Risk factors for postoperative recurrence were also examined, including preoperative endoscopic treatment (odds ratio 3.59, 95% CI 1.18-10.9, P = .024), positive venous invasion (odds ratio 3.63, 95% CI 1.22-10.8, P = .021), positive lymph node metastasis (odds ratio 4.91, 95% CI 1.10-21.8, P = .037) were extracted as risk factors. Discussion In this study, venous invasion, lymphatic invasion, and histologically poorly differentiated type were identified as risk factors for lymph node metastasis in T1 colorectal cancer, and positive venous invasion, positive lymph node metastasis, and preoperative endoscopic treatment were identified as risk factors for recurrence. We hope that large prospective study will lead to the development of a more specific treatment strategy, including endoscopic treatment and additional surgical resection.

High serum mannose in colorectal cancer: a novel biomarker of lymph node metastasis and poor prognosis

“…With regard to the analysis of clinicopathologic factors, the results of this study suggested that independent risk factors for LNM in CRC included poorer histologic grade, LVI and CEA; in addition, histologic grade (G3), histologic grade (mucin-producing subtype), depth of invasion(T3-T4), and LVI were associated with poor prognosis. The above results were consistent with previous studies ( 32 – 35 ). The consensus molecular subtypes (CMS) of colorectal cancer indicated that the metabolic subtype (CMS3) potentially associated with Man metabolism and mucinous differentiation ( 36 ).…”

Differentiation grade as a risk factor for lymph node metastasis in T1 colorectal cancer

“…Among the nine single institutions, the least differentiation analysis was used in four, the predominant differentiation analysis was adopted in four, and the method used in the remaining one institution was unclear. 8,[16][17][18][20][21][22][23]25 When classified by the predominant differentiation analysis, 0.8% (8/971) of the cohort was defined as high-grade in the present study which is equal to the 0.6%-5.0% found in the previous studies with the predominant differentiation analysis. 16,20,22,23 It suggests that this method may lack the sensitivity to act as a risk factor.…”

“…However, the assessment of tumor grade according to the least or predominant component actually depends on the institution in Japan (Table 1). Among the nine single institutions, the least differentiation analysis was used in four, the predominant differentiation analysis was adopted in four, and the method used in the remaining one institution was unclear 8,16–18,20–23,25 . When classified by the predominant differentiation analysis, 0.8% (8/971) of the cohort was defined as high‐grade in the present study which is equal to the 0.6%–5.0% found in the previous studies with the predominant differentiation analysis 16,20,22,23 .…”

“…Tumor grading is classified by the least differentiation according to the World Health Organization (WHO) classification, and by the predominant differentiation using Japanese guidelines (Figure 1). 13,14 Nevertheless, even within Japan, the method of classifying tumor grade varies by institution 8,15–25 . Two recent expansive Japanese multicenter studies encompassing over 4000 T1 CRC cases diverged in their methodologies—one utilizing predominant differentiation analysis, the other least differentiation analysis (Table 1).…”

“… 13 , 14 Nevertheless, even within Japan, the method of classifying tumor grade varies by institution. 8 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 Two recent expansive Japanese multicenter studies encompassing over 4000 T1 CRC cases diverged in their methodologies—one utilizing predominant differentiation analysis, the other least differentiation analysis (Table 1 ). In other words, the decision to perform additional surgical resection following endoscopic resection depends on whether the analysis is based on the least or most predominant differentiation.…”