Ann Surg Treat Res.  2017 Nov;93(5):266-271. 10.4174/astr.2017.93.5.266.

Histopathologic risk factors for lymph node metastasis in patients with T1 colorectal cancer

• Ha RK
• Han KS
• Sohn DK
• Kim BC
• Hong CW
• Chang HJ
• Hyun JH
• Kim MJ
• Park SC
• Oh JH

• KMID: 2393992
• DOI: http://doi.org/10.4174/astr.2017.93.5.266

Abstract

PURPOSE
Evaluating the risk of lymph node metastasis (LNM) is critical for determining subsequent treatments following endoscopic resection of T1 colorectal cancer (CRC). This study analyzed histopathologic risk factors for LNM in patients with T1 CRC.
METHODS
This study involved 745 patients with T1 CRC who underwent endoscopic (n = 97) or surgical (n = 648) resection between January 2001 and December 2015 at the National Cancer Center, Korea. LNM in endoscopically resected patients, which could not be evaluated directly, was estimated indirectly based on follow-up results and histopathologic reports of salvage surgery. The relationships of depth of submucosal invasion, histologic grade, budding, vascular invasion, and background adenoma with LNM were evaluated statistically.
RESULTS
Of the 745 patients, 91 (12.2%) were found to be positive for LNM. Univariate and multivariate analyses identified deep submucosal invasion (P = 0.010), histologic high grade (P < 0.001), budding (P = 0.034), and vascular invasion (P < 0.001) as risk factors for LNM. Among the patients with one, two, three, and four risk factors, 6.0%, 18.7%, 36.4%, and 100%, respectively, were positive for LNM.
CONCLUSION
Deep submucosal invasion, histologic high grade, budding, and vascular invasion are risk factors for LNM in patients with T1 colorectal cancer. If any of these risk factors are present, additional surgery following endoscopic resection should be determined after considering the potential risk of LNM and each patient's situation.

Keyword

Colorectal neoplasm; Colonoscopy; Lymphatic metastasis

MeSH Terms

Adenoma
Colonoscopy
Colorectal Neoplasms*
Follow-Up Studies
Humans
Korea
Lymph Nodes*
Lymphatic Metastasis
Multivariate Analysis
Neoplasm Metastasis*
Risk Factors*

Figure

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  Fig. 1 Pathway for estimating the status of lymph node metastasis (LNM) in endoscopically resected patients. CRC, colorectal cancer.

Reference

1. Gupta AK, Melton LJ 3rd, Petersen GM, Timmons LJ, Vege SS, Harmsen WS, et al. Changing trends in the incidence, stage, survival, and screen-detection of colorectal cancer: a population-based study. Clin Gastroenterol Hepatol. 2005; 3:150–158.

2. Haggitt RC, Glotzbach RE, Soffer EE, Wruble LD. Prognostic factors in colorectal carcinomas arising in adenomas: implications for lesions removed by endoscopic polypectomy. Gastroenterology. 1985; 89:328–336.

3. Kyzer S, Begin LR, Gordon PH, Mitmaker B. The care of patients with colorectal polyps that contain invasive adenocarcinoma. Endoscopic polypectomy or colectomy. Cancer. 1992; 70:2044–2050.

4. Kikuchi R, Takano M, Takagi K, Fujimoto N, Nozaki R, Fujiyoshi T, et al. Management of early invasive colorectal cancer. Risk of recurrence and clinical guidelines. Dis Colon Rectum. 1995; 38:1286–1295.

5. Nascimbeni R, Burgart LJ, Nivatvongs S, Larson DR. Risk of lymph node metastasis in T1 carcinoma of the colon and rectum. Dis Colon Rectum. 2002; 45:200–206.

6. Kitajima K, Fujimori T, Fujii S, Takeda J, Ohkura Y, Kawamata H, et al. Correlations between lymph node metastasis and depth of submucosal invasion in submucosal invasive colorectal carcinoma: a Japanese collaborative study. J Gastroenterol. 2004; 39:534–543.

7. Sohn DK, Chang HJ, Park JW, Choi DH, Han KS, Hong CW, et al. Histopathological risk factors for lymph node metastasis in submucosal invasive colorectal carcinoma of pedunculated or semipedunculated type. J Clin Pathol. 2007; 60:912–915.

8. National Comprehensive Cancer Network clinical practice guidelines in oncology (NCCN Guidelines): colon cancer. Version 2. 2016. Fort Wathington (PA): National Comprehensive Cancer Network;c2017. cited 2017 Jan 5. Available from: http://www.nccn.org/professionals/physician_gls/f_guidelines.asp.

9. National Comprehensive Cancer Network clinical practice guidelines in oncology (NCCN Guidelines): rectal cancer. Version 1. 2016. Fort Wathington (PA): National Comprehensive Cancer Network;c2017. cited 2017 Jan 5. Available from: http://www.nccn.org/professionals/physician_gls/f_guidelines.asp.

10. Watanabe T, Itabashi M, Shimada Y, Tanaka S, Ito Y, Ajioka Y, et al. Japanese Society for Cancer of the Colon and Rectum (JSCCR) Guidelines 2014 for treatment of colorectal cancer. Int J Clin Oncol. 2015; 20:207–239.

11. Ueno H, Mochizuki H, Hashiguchi Y, Shimazaki H, Aida S, Hase K, et al. Risk factors for an adverse outcome in early invasive colorectal carcinoma. Gastroenterology. 2004; 127:385–394.

12. Choi DH, Sohn DK, Chang HJ, Lim SB, Choi HS, Jeong SY. Indications for subsequent surgery after endoscopic resection of submucosally invasive colorectal carcinomas: a prospective cohort study. Dis Colon Rectum. 2009; 52:438–445.

13. Tateishi Y, Nakanishi Y, Taniguchi H, Shimoda T, Umemura S. Pathological prognostic factors predicting lymph node metastasis in submucosal invasive (T1) colorectal carcinoma. Mod Pathol. 2010; 23:1068–1072.

14. Suh JH, Han KS, Kim BC, Hong CW, Sohn DK, Chang HJ, et al. Predictors for lymph node metastasis in T1 colorectal cancer. Endoscopy. 2012; 44:590–595.

15. The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon: November 30 to December 1, 2002. Gastrointest Endosc. 2003; 58:6 Suppl. S3–S43.

16. Kudo S. Endoscopic mucosal resection of flat and depressed types of early colorectal cancer. Endoscopy. 1993; 25:455–461.

17. Hamilton S, Aaltonen L. WHO Classification of Tumours. Pathology and genetics of tumours of the digestive system. Lyon: IARC press;2000. (World Health Organization classification of tumours; v. 2).

18. Ueno H, Price AB, Wilkinson KH, Jass JR, Mochizuki H, Talbot IC. A new prognostic staging system for rectal cancer. Ann Surg. 2004; 240:832–839.

19. Toh EW, Brown P, Morris E, Botterill I, Quirke P. Area of submucosal invasion and width of invasion predicts lymph node metastasis in pT1 colorectal cancers. Dis Colon Rectum. 2015; 58:393–400.

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

21. Hase K, Shatney C, Johnson D, Trollope M, Vierra M. Prognostic value of tumor “budding” in patients with colorectal cancer. Dis Colon Rectum. 1993; 36:627–635.

22. Vogelstein B, Fearon ER, Hamilton SR, Kern SE, Preisinger AC, Leppert M, et al. Genetic alterations during colorectal-tumor development. N Engl J Med. 1988; 319:525–532.

23. Shimoda T, Ikegami M, Fujisaki J, Matsui T, Aizawa S, Ishikawa E. Early colorectal carcinoma with special reference to its development de novo. Cancer. 1989; 64:1138–1146.