T1 colon cancer in the era of screening: risk factors and treatment

Bianco, Francesco; Franciscis, Silvia De; Belli, Andrea; Falato, Armando; Fusco, Roberta; Altomare, Donato F.; Amato, Antonio; Asteria, C. R.; Avallone, Antonio; Binda, Gian Andrea; Boccia, Luigi; Buzzo, P.; Carvello, Michele; Coco, Claudio; Delrio, Paolo; Nardi, Paola De; Lena, Maria Di; Failla, Andrea; Torre, Filippo La; Torre, M. La; Lemma, Maria; Luffarelli, Paolo; Manca, Giuseppe; Maretto, Isacco; Marino, F.; Muratore, Andrea; Pascariello, A.; Rega, Daniela; Ripetti, V.; Rizzo, Gianluca; Serventi, A.; Spinelli, Antonino; Tatangelo, Fabiana; Urso, Emanuele; Romano, G.

doi:10.1007/s10151-017-1586-z

Cited by 8 publications

(10 citation statements)

References 39 publications

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“…We still observed a fairly high surgery referral rate (27.6%) among patients with well characterised low-risk cancerized adenomas. Many studies [21,22,31,32] documented that endoscopic removal of these lesions is associated with very low rates of recurrence and with a high disease-free and overall survival, often approaching 100% at five-year follow-up, while surgical treatment may be associated with a high potential for morbidity. According to our data, about 15% of patients experienced post-surgery complications, with a significant increase of direct and indirect costs.…”

Section: Residual Disease and Nodal Involvementmentioning

confidence: 99%

Management of Pt1 tumours removed by endoscopy during colorectal cancer screening: Outcome and treatment quality indicators

Senore

Giovo

Ribaldone

et al. 2018

European Journal of Surgical Oncology

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Introduction: Limited information is available about outcomes of patients with malignant adenomas endoscopically resected at screening. The aim of the study was to evaluate diagnostic and therapeutic quality indicators and to correlate them with clinical and surgical outcomes. Materials and Methods: We reviewed endoscopic and histology characteristics of all pT1 tumours endoscopically removed at the time of colonoscopy assessment in subjects with a positive screening test result in the context of a population-based program. Results: 392 pT1 tumours were completely removed by endoscopy (en-bloc= 86.7%, piecemeal= 13.3%) and the histology report was considered complete in 83.2% of cases. Treatment was limited to endoscopic excision for 120 patients (30.7%, Group 1), 272 (69.3%, Group 2) underwent radicalisation surgery. In patients who had at least 1 lymph node examined, the rate of nodal involvement was 5.4% (13/239); no metastatic node was found in the 21 (27.6%) out of 76 patients with low-risk adenomas, who underwent surgery. Conclusion: Risk of nodal involvement in colorectal pT1 tumours is well predicted by known histologic features also in a screening setting, although it was lower than among patients from clinical series. Surgical overtreatment is still significantly present and there is ample room for improvement regarding diagnostic and therapeutic flow-chart.

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Section: Residual Disease and Nodal Involvementmentioning

confidence: 99%

Management of Pt1 tumours removed by endoscopy during colorectal cancer screening: Outcome and treatment quality indicators

Senore

Giovo

Ribaldone

et al. 2018

European Journal of Surgical Oncology

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“…From these articles, 90 articles were excluded because the papers were not in English or Chinese (n=2), had unavailable data (n=23) and were unrelated (n=65). Finally, 54 studies were included, with 30 included in the systematic review,5 19–47 and 24 in the meta-analysis (figure 1). 12–14 48–68…”

Section: Resultsmentioning

confidence: 99%

“…In the systematic review, 20 articles revealed no significant association between age and the retrieval of LNs in colorectal cancer 21–23 26 27 30 32 35 37–41 47–49 54 55 64 65. However, 18 articles indicated that more LNs were obtained from young patients than elderly patients (online supplemental table 6).…”

Section: Resultsmentioning

confidence: 99%

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Association between the number of retrieved lymph nodes and demographic/tumour-related characteristics in colorectal cancer: a systematic review and meta-analysis

Liu,

Huang,

Yang

et al. 2023

BMJ Open

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ObjectiveClinical practice guidelines recommend retrieving at least 12 lymph nodes for correct staging in colorectal cancer. However, it is difficult to retrieve adequate lymph nodes because of various factors. We aimed to evaluate the association between the number of retrieved lymph nodes and demographic/tumour-related characteristics in colorectal cancer.DesignSystematic review and meta-analysis of primary studies.Data sourcesPubMed, Embase, Cochrane and Web of Science were searched from January 2016 to June 2023.Eligibility criteria for selecting studiesStudies that evaluated the association between retrieved lymph nodes and demographic/tumour-related characteristics in colorectal cancer were included.Data extraction and synthesisOR with 95% conference intervals was extracted and pooled.ResultsA total of 54 studies containing 2 05 821 patients were included in this meta-analysis. The results showed that fewer nodes were retrieved from elderly patients (OR=0.70, 95% CI (0.54 to 0.90), p=0.005), and from tumours located in the left colon than in the right colon (OR=0.43, 95% CI (0.33 to 0.56), p<0.001). More lymph nodes were obtained from females than males (OR=1.15, 95% CI (1.04 to 1.28), p=0.006), from the advanced T stage (T3+T4) than T1+T2 stage (OR=1.57, 95% CI (1.25 to 1.97), p<0.001) and from the N2 stage than N0 stage (OR=1.32, 95% CI (1.15 to 1.51), p<0.001). Body mass index, ethnicity, N1 stage, M stage, tumour differentiation and lymph–vascular invasion were not significantly associated with the lymph node yield.ConclusionsThe study results suggest that clinicians have an increased opportunity to retrieve sufficient lymph nodes for accurate pathological staging to guide treatment decisions in patients with colorectal cancer who are young, female, with tumours located in the right colon, advanced T stage and N2 stage.

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“…Furthermore, there is insufficient evidence regarding long-term outcomes of patients with surgically resected T1 CRC in heterogeneous Western populations [ 16 ]. Predictive factors such as lymphovascular invasion, tumor budding, and submucosal invasion depth are difficult to assess after endoscopic therapies [ 17 ]. Conversely, homogeneous patient and tumor characteristics might provide more appropriate indicators for the treatment of T1 CRC.…”

Section: Introductionmentioning

confidence: 99%

Predictors of lymph-node metastasis in surgically resected T1 colorectal cancer in Western populations

Zong

et al. 2021

Gastroenterology Report

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Background The risk of lymph-node metastasis (LNM) in T1 colorectal cancer (CRC) has not been well documented in heterogeneous Western populations. This study investigated the predictors of LNM and the long-term outcomes of patients by analysing T1 CRC surgical specimens and patients’ demographic data. Methods Patients with surgically resected T1 CRC between 2004 and 2014 were identified from the Surveillance, Epidemiology, and End Results (SEER) database. Patients with multiple primary cancers, with neoadjuvant therapy, or without a confirmed histopathological diagnosis were excluded. Multivariate logistic-regression analysis was used to identify the predictors of LNM. Results Of the 22,319 patients, 10.6% had a positive lymph-node status based on the final pathology (nodal category: N1 9.6%, N2 1.0%). Younger age, female sex, Asian or African-American ethnicity, poor differentiation, and tumor site outside the rectum were significantly associated with LNM. Subgroup analyses for patients stratified by tumor site suggested that the rate of positive lymph-node status was the lowest in the rectum (hazard ratio: 0.74; 95% confidence interval: 0.63–0.86). Conclusion The risk of LNM was potentially lower in Caucasian patients than in API or African-American patients with surgically resected T1 CRC. Regarding the T1 CRC site, the rectum was associated with a lower risk of LNM.

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T1 colon cancer in the era of screening: risk factors and treatment

Cited by 8 publications

References 39 publications

Management of Pt1 tumours removed by endoscopy during colorectal cancer screening: Outcome and treatment quality indicators

Management of Pt1 tumours removed by endoscopy during colorectal cancer screening: Outcome and treatment quality indicators

Association between the number of retrieved lymph nodes and demographic/tumour-related characteristics in colorectal cancer: a systematic review and meta-analysis

Predictors of lymph-node metastasis in surgically resected T1 colorectal cancer in Western populations

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