Systematic review and meta-analysis of histopathological predictive factors for lymph node metastasis in T1 colorectal cancer

Wada, Hiroo; Shiozawa, Manabu; Katayama, Kazuhisa; Okamoto, Naoyuki; Miyagi, Yohei; Rino, Yasushi; Masuda, Munetaka; Amaki, Makoto

doi:10.1007/s00535-015-1057-0

Cited by 88 publications

(75 citation statements)

References 20 publications

(38 reference statements)

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“…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: 92%

“…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.…”

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confidence: 99%

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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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Section: Discussionmentioning

confidence: 92%

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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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“…Although this value did not reach statistical significance in our patients, a type II error may exist due to the small numbers of patients in the subgroups. While lymphovascular invasion, tumor differentiation, tumor budding, and low rectal tumors have been suggested as predictors of lymph node metastasis in early colorectal cancer by various authors [1,12,19,20]. Kikuchi et al reported that lymphovascular invasion, diameter and histologic grade of adenocarcinoma are not predictors of lymph node metastasis in T1 colorectal carcinoma [21].…”

Section: Discussionmentioning

confidence: 99%

Impact of tumor location on lymph node metastasis in T1 colorectal cancer

Aytaç

Görgün

Costedio

et al. 2016

Langenbecks Arch Surg

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“…In colorectal cancer, tumor budding has already been accepted as an additional prognostic factor [29] and it is recognized as an important risk factor for lymph node metastases in the endoscopic treatment of early colorectal cancer [30]. Tumor budding was also reported as the prognostic factor for lymph node metastasis in other cancers such as esophageal, laryngeal, nasopharyngeal, and skin cancers [31][32][33][34].…”

Section: Discussionmentioning

confidence: 99%

Predictive Significance of Tumor Depth and Budding for Late Lymph Node Metastases in Patients with Clinical N0 Early Oral Tongue Carcinoma

Hori

Kubota

Yokose

et al. 2017

Head and Neck Pathol

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Systematic review and meta-analysis of histopathological predictive factors for lymph node metastasis in T1 colorectal cancer

Abstract: Our meta-analysis revealed that lymphatic vessel invasion identified by an anti-human podoplanin antibody and tumor budding were significantly associated with T1 colorectal cancer lymph node metastasis.

Cited by 88 publications

References 20 publications

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

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

Impact of tumor location on lymph node metastasis in T1 colorectal cancer

Predictive Significance of Tumor Depth and Budding for Late Lymph Node Metastases in Patients with Clinical N0 Early Oral Tongue Carcinoma

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