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Condition of muscularis mucosae is a risk factor for lymph node metastasis in T1 colorectal carcinoma

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Abstract

Background

The Japanese Society for Cancer of the Colon and Rectum Guidelines for the Treatment of Colorectal Cancer 2010 state that curable T1 colorectal carcinoma (CRC) after endoscopic resection shows favorable histologic grade, absence of vessel involvement, submucosal invasion depth of <1,000 μm, and low-grade tumor budding.

Methods

We evaluated 322 consecutive T1 CRCs with LN dissection between January 1993 and March 2012. According to the muscularis mucosae condition, CRCs were classified into three groups: type A, clearly identified; type B, incompletely disrupted with deformity; or type C, completely disrupted. We examined the relationship between the muscularis mucosae condition, clinicopathological findings, and lymph node (LN) metastasis.

Results

The overall incidence of LN metastasis was 11.8 % (38/322): 0 % (0/46) for the type A group, 7.2 % (7/97) for the type B group, and 17.3 % (31/179) for the type C group. In univariate analysis of type B and C groups, unfavorable histologic grade, submucosal invasion of ≥1,000 μm, positive lymphatic invasion, high-grade tumor budding, and the type C group were associated with a significantly higher incidence of LN metastasis. In multivariate analysis, high-grade tumor budding (P < 0.001, odds ratio [OR] = 4.86), unfavorable histologic grade (P = 0.026, OR = 4.83), positive lymphatic invasion (P < 0.001, OR = 4.17), and the type C group (P = 0.012, OR = 3.38) were significantly associated with LN metastasis. The type C group showed a high incidence of moderate/severe lymphatic invasion.

Conclusions

The condition of the muscularis mucosae was an indicator of LN metastasis in T1 CRC.

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Disclosure

Koichi Nakadoi, Shiro Oka, Shinji Tanaka, Nana Hayashi, Motomi Terasaki, Koji Arihiro, Fumio Shimamoto, and Kazuaki Chayama have no conflict of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Gastroenterology and Metabolism, Graduate School of Biochemical Sciences, Hiroshima University, Hiroshima, Japan

    Koichi Nakadoi, Nana Hayashi, Motomi Terasaki & Kazuaki Chayama

  2. Department of Endoscopy, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan

    Shiro Oka & Shinji Tanaka

  3. Department of Pathology, Hiroshima University Hospital, Hiroshima, Japan

    Koji Arihiro

  4. Department of Health Science, Faculty of Human Culture and Society, Prefectural University of Hiroshima, Hiroshima, Japan

    Fumio Shimamoto

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  1. Koichi Nakadoi
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Correspondence to Shiro Oka.

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Nakadoi, K., Oka, S., Tanaka, S. et al. Condition of muscularis mucosae is a risk factor for lymph node metastasis in T1 colorectal carcinoma. Surg Endosc 28, 1269–1276 (2014). https://doi.org/10.1007/s00464-013-3321-9

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