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The risk of lymph node metastasis in T1 colorectal cancer: new parameters to assess the degree of submucosal invasion

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

In T1 colorectal cancer, the depth is the main factor assessing the degree of submucosal invasion (DSI) to predict the risk of lymph node metastasis (LNM). The width (WSI) and the area of submucosal invasion (ASI) have been suggested as additional parameters to assess the risk of LNM. A review of the literature was undertaken on the correlation between WSI and ASI parameters and the incidence of LNM.

Methods

A Medline, PubMed, and Cochrane Library search was performed to retrieve all studies reporting correlation between WSI/ASI and risk of LNM in T1 colorectal cancer.

Results

Eight studies including 1727 patients were identified. All considered the degree of WSI and its influence on LNM: seven assessed different width cut-off of submucosal invasion, and one study the mean width of submucosal invasion in patients having or not involved lymph nodes. The WSI was significantly a prognostic factor for LNM (p < 0.05) in four studies. Both 2 and 3 mm seem to be the most discriminatory cut-off values of submucosal width invasion in defining the risk difference of LNM above and below the cut-off (2 mm, OR = infinite; 3 mm, OR = 6.9). Patients having a cut-off ≤ 5 mm of WSI showed a low risk (5.6%) of LNM rendering radical surgery unnecessary. Four studies assessed the risk of LNM according to the involved submucosal area (width × depth). In two of these, the ASI was a significant prognostic factor for LNM (p < 0.05).

Conclusion

The WSI and ASI seem to be reliable prognostic factors for LNM in T1 colorectal cancer. There is no agreement on ideal cut-off value.

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References

  1. Glynne-Jones R, Wyrwicz L, Tiret E, Brown G, Rodel C, Cervantes A, Arnold D (2017) Rectal cancer ESMO clinical practice guidelines. Ann Oncol 28(suppl 4):iv22–iv40

    Article  CAS  Google Scholar 

  2. Davenport A, Morris J, Pritchard SA, Salmo E, Scott M, Haboubi NY (2016) Interobserver variability amongst gastrointestinal pathologists in assessing prognostic parameters of malignant colorectal polyps: a cause for concern. Tech Coloproctol 20(9):647–652

    Article  CAS  Google Scholar 

  3. Kicuchi R, Takano M, Takagi K, Fujimoto N, Nozaki R, Fujiyoshi T, Uchida Y (1995) Management of early invasive colorectal cancer: risk of recurrence and clinical guidelines. Dis Colon Rectum 38(12):1286–1295

    Article  Google Scholar 

  4. Kudo S (1993) Endoscopic mucosal resection of flat and depressed types of early colorectal cancer. Endoscopy 25(7):455–461

    Article  CAS  Google Scholar 

  5. Zinicola R, Hill J, Fiocca R (2014) Surgery for colorectal polyps: histological features, current indications, critical points, future perspective and ongoing studies. Color Dis 17 Suppl 1:52–60

    Google Scholar 

  6. Nicholls RJ, Zinicola R, Binda GA (2004) Indications for colorectal resection for adenoma before and after polypectomy. Tech Coloproctol 8(Suppl 2):s291–s294

    Article  Google Scholar 

  7. Ueno H, Mochizuchi H, Hashiguchi Y, Shimazaki H, Aida S, Hase K, Matsukuma S, Kanai T, Kurihara H, Ozawa K, Yoshimura K, Bekku S (2004) Risk factors for an adverse outcome in early invasive colorectal carcinoma. Gastroenterology 127(2):385–394

    Article  Google Scholar 

  8. Toh EW, Broen P, Morris E, Botterill I, Quirke P (2015) Area of submucosal invasion and width of invasion predicts lymph node metastasis in pT1 colorectal cancers. Dis Colon Rectum 58(4):393–340

    Article  Google Scholar 

  9. Suzuki T, Sadahiro S, Mukoyama S, Ishikawa K, Yasuda S, Tajima T, Makuuchi H, Murayama C (2003) Risk of lymph node and distant metastases in patients with early invasive colorectal cancer classified as Haggitt’s level 4 invasion: image analysis of submucosal layer invasion. Dis Colon Rectum 46(2):203–208

    Article  Google Scholar 

  10. Okabe S, Shia JS, Nash G, Wong WD, Guillem JG, Weiser MR, Temple L, Sugihara K, Paty PB (2004) Lymph node metastasis in T1 adenocarcinoma of the colon and rectum. J Gastrointest Surg 8(8):1032–1039 discussion 1039-40

    Article  Google Scholar 

  11. Tominaga K, Nakanishi Y, Nimura S, Yoshimura K, Sakai Y, Shimoda T (2005) Predictive histopathologic factors for lymph node metastasis in patients with non pedunculated submucosal invasive colorectal carcinoma. Dis Colon Rectum 48(1):92–100

    Article  Google Scholar 

  12. Yim K, Won DD, Lee IK, Oh ST, Jung ES, Lee SH (2017) Novel predictors for lymph node metastasis in submucosal invasive colorectal carcinoma. World J Gastroenterol 23(32):5936–5944

    Article  Google Scholar 

  13. Barel F, Cariou M, Philippe S, Kermarrec T, Auffret A, Samaison L, Bourhis A, Badic B, Jezequel J, Cholet F, Bail JP, Marcorelles P, Nousbaum JB, Robaszkiewicz M, Doucet L, Uguen A (2019) Histopathological factors help to predict lymph node metastases more efficiently than extra-nodal recurrences in submucosa invading pT1 colorectal cancer. Sci Rep 9(1):8342 1–12

    Article  Google Scholar 

  14. Egashira Y, Yoshida T, Hirata I, Hamamoto N, Akutagawa H, Takeshita A, Noda N, Kurisu Y, Shibayama Y (2004) Analysis of pathological risk factors for lymph node metastasis of submucosal invasive colon cancer. Mod Pathol 17(5):503–511

    Article  CAS  Google Scholar 

  15. Haboubi N, Salmo E (2013) Are we accurately measuring the depth of the submucosal invasion in early colorectal cancer by equating the Kikuchi submucosa levels with distanced measured in fractions of a millimeter? Color Dis 15(7):775–777

    Article  Google Scholar 

  16. Masaki T, Sugiyama M, Matsuoka H, Abe N, Izumisato Y, Goto A, Sakamoto A, Atomi Y (2003) Clinical utility of grading criteria for submucosal invasion in the prognosis of T1 colorectal carcinomas. J Gastroenterol 38(1):37–44

    Article  Google Scholar 

  17. Debove C, Svrcek M, Dumont S, Chafai N, Tiret E, Parc Y, Lefevre JH (2016) Is the assessment of submucosal invasion still useful in the management of early rectal cancer? A study of 91 consecutive patients. Color Dis 19(1):27–37

    Article  Google Scholar 

  18. Kouyama Y, Kudo SE, Miyachi H, Ichimasa K, Hisayuki T, Oikawa H, Matsudaira S, Kimura YJ, Misawa M, Mori Y, Kodama K, Kudo T, Hayashi T, Wakamura K, Katagiri A, Hidaka E, Ishida F, Hamatani S (2016) Practical problems of measuring depth of submucosal invasion in T1 colorectal carcinomas. Int J Color Dis 31(1):137–146

    Article  Google Scholar 

  19. Watanabe T, Itabashi M, Shimada Y, Tanaka S, Ito Y, Ajioka Y, Hamaguchi T, Hyodo I, Igarashi M, Ishida H, Ishihara S, Ishiguro M, Kanemitsu Y, Kokudo N, Muro K, Ochiai A, Oguchi M, Ohkura Y, Saito Y, Sakai Y, Ueno H, Yoshino T, Boku N, Fujimori T, Koinuma N, Morita T, Nishimura G, Sakata Y, Takahashi K, Tsuruta O, Yamaguchi T, Yoshida M, Yamaguchi N, Kotake K, Sugihara K, Japanese Society for Cancer of the Colon and Rectum (JSCCR) (2015) Guidelines 2014 for treatment of colorectal cancer. Int J Clin Oncol 20(2):207–239

    Article  Google Scholar 

  20. Wang LM, Guy R, Fryer E, Kartsonaki C, Gill P, Hughes C, Szuts A, Perera R, Chetty R, Mortensen N (2015) The Ueno method for substaging pT1 colorectal adenocarcinoma by depth and width measurement: an interobserver study. Color Dis 17(8):674–681

    Article  CAS  Google Scholar 

  21. Smith KJE, Jones PF, Burke DA, Treanor D, Finan PJ, Quirke P (2011) Lymphatic vessel distribution in the mucosa and submucosa and potential implications for T1 colorectal tumors. Dis Colon Rectum 54(1):35–40

    Article  Google Scholar 

  22. Duff SE, Jeziorska M, Kumar S, Haboubi N, Sherlock D, O'Dwyer ST, Jayson GC (2007) Lymphatic vessel density, microvessel density and lymphangiogenic growth factor expression in colorectal cancer. Color Dis 9(9):793–800

    Article  CAS  Google Scholar 

  23. Brockmoeller SF, West NP (2019) Predicting systemic spread in early colorectal cancer. World J Gastroenterol 25(23):2887–2897

    Article  Google Scholar 

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Authors and Affiliations

  1. General Surgery Unit, IRCCS Sacro Cuore Don Calabria Hospital, 37024, Negrar, Verona, Italy

    Nicola Cracco

  2. General Surgery Unit, M. Mellini Hospital, 25032, Chiari, Brescia, Italy

    Valentina Todaro

  3. Department of Medicine and Surgery-Unit of Neuroscience, Interdepartmental Centre of Robust Statistic (Ro.S.A.), Parma University, 43126, Parma, Italy

    Giuseppe Pedrazzi

  4. General Surgery Unit, University Hospital Parma, 43126, Parma, Italy

    Paolo Del Rio & Roberto Zinicola

  5. Department of Pathology, Spire Healthcare Trust, Manchester, M14 7LU, UK

    Najib Haboubi

Authors
  1. Nicola Cracco
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  2. Valentina Todaro
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  3. Giuseppe Pedrazzi
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  4. Paolo Del Rio
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  5. Najib Haboubi
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  6. Roberto Zinicola
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Contributions

N. Cracco: Wrote the manuscript

R. Zinicola: Ideator and critical revision of the study

N. Haboubi: Critical revision of the study

V. Todaro: Collection data and drafting tables

G. Pedrazzi: Statistical analysis

P. Del Rio: Critical revision of the literature.

Corresponding author

Correspondence to Nicola Cracco.

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The authors declare that they have no conflict of interest.

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Cracco, N., Todaro, V., Pedrazzi, G. et al. The risk of lymph node metastasis in T1 colorectal cancer: new parameters to assess the degree of submucosal invasion. Int J Colorectal Dis 36, 41–45 (2021). https://doi.org/10.1007/s00384-020-03738-0

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  • DOI: https://doi.org/10.1007/s00384-020-03738-0

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