The Risk Analyses of Lymph Node Metastasis and Recurrence for Submucosal Invasive Colorectal Cancer: Novel Criteria to Skip Completion Surgery
(1) Background: Additional surgical resection after endoscopic resection (ER) is recommended for patients with submucosal invasive colorectal cancer (pT1 CRC) who have risk factors for lymph node metastasis (LNM) (high-risk pT1 CRC). This study aimed to identify risk factors for LNM and metastatic r...
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| Veröffentlicht in: | Cancers 2022-02, Vol.14 (3), p.822 |
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| creator | Ozeki, Takanori Shimura, Takaya Ozeki, Tomonori Ebi, Masahide Iwasaki, Hiroyasu Kato, Hiroyuki Inaguma, Shingo Okuda, Yusuke Katano, Takahito Nishie, Hirotada Takahashi, Satoru Kataoka, Hiromi |
| description | (1) Background: Additional surgical resection after endoscopic resection (ER) is recommended for patients with submucosal invasive colorectal cancer (pT1 CRC) who have risk factors for lymph node metastasis (LNM) (high-risk pT1 CRC). This study aimed to identify risk factors for LNM and metastatic recurrence and to determine the low-risk population for whom additional surgery can be omitted among high-risk pT1 CRCs. (2) Methods: We retrospectively identified 404 patients with pT1 CRC who underwent ER or surgery, and patients were divided into three groups: low-risk (
= 79); high-risk pT1 with ER (
= 40); and high-risk with surgery (
= 285). We also enrolled another 64 patients with high-risk pT1 CRC in an independent validation cohort. (3) Results: In the high-risk with surgery group, LNM was seen in 11.2%, and vascular and lymphatic invasions were significantly independent risk factors for LNM on multivariate analysis. No LNMs were observed in pT1 CRCs with a negative vertical margin and SM invasion depth ≤2000 µm that had no other risk factors except for budding. Five patients developed metastatic recurrence in the high-risk with surgery group, and rectal cancer and undifferentiated histology were significantly independent risk factors for poor relapse-free survival. No LNM or recurrent cases were seen in high-risk pT1 CRCs that met these criteria: differentiated adenocarcinoma, no lymphovascular invasion, colon cancer, SM invasion depth ≤2000 μm, and a negative vertical margin, which were validated in an independent validation cohort. (4) Conclusions: Completion surgery may be skipped for high-risk pT1 CRCs that meet our proposed criteria. |
| doi_str_mv | 10.3390/cancers14030822 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8834028</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2627526269</sourcerecordid><originalsourceid>FETCH-LOGICAL-c421t-509dae2f46c6b06e75f5de9ab43d090607627f68414550c08f7356954456257e3</originalsourceid><addsrcrecordid>eNpdkctO3DAUhq2KqiDKurvKEhs2UxxfExZIaNQL0hQkLmvL45wwhiQOdjLSvATPzClQBFiWb-fz73P8E_KtYD-EqNihd72HlAvJBCs5_0R2ODN8pnUlt96st8lezrcMmxCF0eYL2RaqUBUryx3ycLUCehHyHT3pXbvJkGls6GLTDSt6Fmugf2F0GXvI1PU1vQA_pQT4MG1iopfTspt8zK6lp_0aqTXQeWxjAj_i2fwpwyNUWgPuUhghBUfHSC_vwoBkN7QwhtijULqBtPlKPjeuzbD3Mu-S618_r-Z_Zovz36fzk8XMS16MM8Wq2gFvpPZ6yTQY1agaKreUomYV08xobhpdykIqxTwrGyOUrpSUSnNlQOyS42fdAQuA2kM_JtfaIYXOpY2NLtj3kT6s7E1c27IUkvESBQ5eBFK8nyCPtgvZQ9u6HuKULdcc8-BCGkT3P6C3cUr420-UUTjoCqnDZ8qnmHOC5jWZgtl_dtsPduON729reOX_myseASXkqC4</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2627526269</pqid></control><display><type>article</type><title>The Risk Analyses of Lymph Node Metastasis and Recurrence for Submucosal Invasive Colorectal Cancer: Novel Criteria to Skip Completion Surgery</title><source>PubMed Central Open Access</source><source>MDPI - Multidisciplinary Digital Publishing Institute</source><source>EZB-FREE-00999 freely available EZB journals</source><source>PubMed Central</source><creator>Ozeki, Takanori ; Shimura, Takaya ; Ozeki, Tomonori ; Ebi, Masahide ; Iwasaki, Hiroyasu ; Kato, Hiroyuki ; Inaguma, Shingo ; Okuda, Yusuke ; Katano, Takahito ; Nishie, Hirotada ; Takahashi, Satoru ; Kataoka, Hiromi</creator><creatorcontrib>Ozeki, Takanori ; Shimura, Takaya ; Ozeki, Tomonori ; Ebi, Masahide ; Iwasaki, Hiroyasu ; Kato, Hiroyuki ; Inaguma, Shingo ; Okuda, Yusuke ; Katano, Takahito ; Nishie, Hirotada ; Takahashi, Satoru ; Kataoka, Hiromi</creatorcontrib><description>(1) Background: Additional surgical resection after endoscopic resection (ER) is recommended for patients with submucosal invasive colorectal cancer (pT1 CRC) who have risk factors for lymph node metastasis (LNM) (high-risk pT1 CRC). This study aimed to identify risk factors for LNM and metastatic recurrence and to determine the low-risk population for whom additional surgery can be omitted among high-risk pT1 CRCs. (2) Methods: We retrospectively identified 404 patients with pT1 CRC who underwent ER or surgery, and patients were divided into three groups: low-risk (
= 79); high-risk pT1 with ER (
= 40); and high-risk with surgery (
= 285). We also enrolled another 64 patients with high-risk pT1 CRC in an independent validation cohort. (3) Results: In the high-risk with surgery group, LNM was seen in 11.2%, and vascular and lymphatic invasions were significantly independent risk factors for LNM on multivariate analysis. No LNMs were observed in pT1 CRCs with a negative vertical margin and SM invasion depth ≤2000 µm that had no other risk factors except for budding. Five patients developed metastatic recurrence in the high-risk with surgery group, and rectal cancer and undifferentiated histology were significantly independent risk factors for poor relapse-free survival. No LNM or recurrent cases were seen in high-risk pT1 CRCs that met these criteria: differentiated adenocarcinoma, no lymphovascular invasion, colon cancer, SM invasion depth ≤2000 μm, and a negative vertical margin, which were validated in an independent validation cohort. (4) Conclusions: Completion surgery may be skipped for high-risk pT1 CRCs that meet our proposed criteria.</description><identifier>ISSN: 2072-6694</identifier><identifier>EISSN: 2072-6694</identifier><identifier>DOI: 10.3390/cancers14030822</identifier><identifier>PMID: 35159088</identifier><language>eng</language><publisher>Switzerland: MDPI AG</publisher><subject>Adenocarcinoma ; Colon cancer ; Colorectal cancer ; Colorectal carcinoma ; Endoscopy ; Histology ; Invasiveness ; Lymph nodes ; Lymphatic system ; Metastases ; Metastasis ; Morphology ; Multivariate analysis ; Patients ; Rectum ; Risk factors ; Surgery ; Survival ; Tumors</subject><ispartof>Cancers, 2022-02, Vol.14 (3), p.822</ispartof><rights>2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2022 by the authors. 2022</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c421t-509dae2f46c6b06e75f5de9ab43d090607627f68414550c08f7356954456257e3</citedby><cites>FETCH-LOGICAL-c421t-509dae2f46c6b06e75f5de9ab43d090607627f68414550c08f7356954456257e3</cites><orcidid>0000-0002-5888-6217 ; 0000-0002-8139-8158 ; 0000-0001-9491-0723 ; 0000-0002-1451-8500 ; 0000-0001-9507-1714 ; 0000-0002-6048-0021</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8834028/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8834028/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,27924,27925,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35159088$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ozeki, Takanori</creatorcontrib><creatorcontrib>Shimura, Takaya</creatorcontrib><creatorcontrib>Ozeki, Tomonori</creatorcontrib><creatorcontrib>Ebi, Masahide</creatorcontrib><creatorcontrib>Iwasaki, Hiroyasu</creatorcontrib><creatorcontrib>Kato, Hiroyuki</creatorcontrib><creatorcontrib>Inaguma, Shingo</creatorcontrib><creatorcontrib>Okuda, Yusuke</creatorcontrib><creatorcontrib>Katano, Takahito</creatorcontrib><creatorcontrib>Nishie, Hirotada</creatorcontrib><creatorcontrib>Takahashi, Satoru</creatorcontrib><creatorcontrib>Kataoka, Hiromi</creatorcontrib><title>The Risk Analyses of Lymph Node Metastasis and Recurrence for Submucosal Invasive Colorectal Cancer: Novel Criteria to Skip Completion Surgery</title><title>Cancers</title><addtitle>Cancers (Basel)</addtitle><description>(1) Background: Additional surgical resection after endoscopic resection (ER) is recommended for patients with submucosal invasive colorectal cancer (pT1 CRC) who have risk factors for lymph node metastasis (LNM) (high-risk pT1 CRC). This study aimed to identify risk factors for LNM and metastatic recurrence and to determine the low-risk population for whom additional surgery can be omitted among high-risk pT1 CRCs. (2) Methods: We retrospectively identified 404 patients with pT1 CRC who underwent ER or surgery, and patients were divided into three groups: low-risk (
= 79); high-risk pT1 with ER (
= 40); and high-risk with surgery (
= 285). We also enrolled another 64 patients with high-risk pT1 CRC in an independent validation cohort. (3) Results: In the high-risk with surgery group, LNM was seen in 11.2%, and vascular and lymphatic invasions were significantly independent risk factors for LNM on multivariate analysis. No LNMs were observed in pT1 CRCs with a negative vertical margin and SM invasion depth ≤2000 µm that had no other risk factors except for budding. Five patients developed metastatic recurrence in the high-risk with surgery group, and rectal cancer and undifferentiated histology were significantly independent risk factors for poor relapse-free survival. No LNM or recurrent cases were seen in high-risk pT1 CRCs that met these criteria: differentiated adenocarcinoma, no lymphovascular invasion, colon cancer, SM invasion depth ≤2000 μm, and a negative vertical margin, which were validated in an independent validation cohort. (4) Conclusions: Completion surgery may be skipped for high-risk pT1 CRCs that meet our proposed criteria.</description><subject>Adenocarcinoma</subject><subject>Colon cancer</subject><subject>Colorectal cancer</subject><subject>Colorectal carcinoma</subject><subject>Endoscopy</subject><subject>Histology</subject><subject>Invasiveness</subject><subject>Lymph nodes</subject><subject>Lymphatic system</subject><subject>Metastases</subject><subject>Metastasis</subject><subject>Morphology</subject><subject>Multivariate analysis</subject><subject>Patients</subject><subject>Rectum</subject><subject>Risk factors</subject><subject>Surgery</subject><subject>Survival</subject><subject>Tumors</subject><issn>2072-6694</issn><issn>2072-6694</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNpdkctO3DAUhq2KqiDKurvKEhs2UxxfExZIaNQL0hQkLmvL45wwhiQOdjLSvATPzClQBFiWb-fz73P8E_KtYD-EqNihd72HlAvJBCs5_0R2ODN8pnUlt96st8lezrcMmxCF0eYL2RaqUBUryx3ycLUCehHyHT3pXbvJkGls6GLTDSt6Fmugf2F0GXvI1PU1vQA_pQT4MG1iopfTspt8zK6lp_0aqTXQeWxjAj_i2fwpwyNUWgPuUhghBUfHSC_vwoBkN7QwhtijULqBtPlKPjeuzbD3Mu-S618_r-Z_Zovz36fzk8XMS16MM8Wq2gFvpPZ6yTQY1agaKreUomYV08xobhpdykIqxTwrGyOUrpSUSnNlQOyS42fdAQuA2kM_JtfaIYXOpY2NLtj3kT6s7E1c27IUkvESBQ5eBFK8nyCPtgvZQ9u6HuKULdcc8-BCGkT3P6C3cUr420-UUTjoCqnDZ8qnmHOC5jWZgtl_dtsPduON729reOX_myseASXkqC4</recordid><startdate>20220206</startdate><enddate>20220206</enddate><creator>Ozeki, Takanori</creator><creator>Shimura, Takaya</creator><creator>Ozeki, Tomonori</creator><creator>Ebi, Masahide</creator><creator>Iwasaki, Hiroyasu</creator><creator>Kato, Hiroyuki</creator><creator>Inaguma, Shingo</creator><creator>Okuda, Yusuke</creator><creator>Katano, Takahito</creator><creator>Nishie, Hirotada</creator><creator>Takahashi, Satoru</creator><creator>Kataoka, Hiromi</creator><general>MDPI AG</general><general>MDPI</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7T5</scope><scope>7TO</scope><scope>7XB</scope><scope>8FE</scope><scope>8FH</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>H94</scope><scope>HCIFZ</scope><scope>LK8</scope><scope>M2O</scope><scope>M7P</scope><scope>MBDVC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-5888-6217</orcidid><orcidid>https://orcid.org/0000-0002-8139-8158</orcidid><orcidid>https://orcid.org/0000-0001-9491-0723</orcidid><orcidid>https://orcid.org/0000-0002-1451-8500</orcidid><orcidid>https://orcid.org/0000-0001-9507-1714</orcidid><orcidid>https://orcid.org/0000-0002-6048-0021</orcidid></search><sort><creationdate>20220206</creationdate><title>The Risk Analyses of Lymph Node Metastasis and Recurrence for Submucosal Invasive Colorectal Cancer: Novel Criteria to Skip Completion Surgery</title><author>Ozeki, Takanori ; Shimura, Takaya ; Ozeki, Tomonori ; Ebi, Masahide ; Iwasaki, Hiroyasu ; Kato, Hiroyuki ; Inaguma, Shingo ; Okuda, Yusuke ; Katano, Takahito ; Nishie, Hirotada ; Takahashi, Satoru ; Kataoka, Hiromi</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c421t-509dae2f46c6b06e75f5de9ab43d090607627f68414550c08f7356954456257e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Adenocarcinoma</topic><topic>Colon cancer</topic><topic>Colorectal cancer</topic><topic>Colorectal carcinoma</topic><topic>Endoscopy</topic><topic>Histology</topic><topic>Invasiveness</topic><topic>Lymph nodes</topic><topic>Lymphatic system</topic><topic>Metastases</topic><topic>Metastasis</topic><topic>Morphology</topic><topic>Multivariate analysis</topic><topic>Patients</topic><topic>Rectum</topic><topic>Risk factors</topic><topic>Surgery</topic><topic>Survival</topic><topic>Tumors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ozeki, Takanori</creatorcontrib><creatorcontrib>Shimura, Takaya</creatorcontrib><creatorcontrib>Ozeki, Tomonori</creatorcontrib><creatorcontrib>Ebi, Masahide</creatorcontrib><creatorcontrib>Iwasaki, Hiroyasu</creatorcontrib><creatorcontrib>Kato, Hiroyuki</creatorcontrib><creatorcontrib>Inaguma, Shingo</creatorcontrib><creatorcontrib>Okuda, Yusuke</creatorcontrib><creatorcontrib>Katano, Takahito</creatorcontrib><creatorcontrib>Nishie, Hirotada</creatorcontrib><creatorcontrib>Takahashi, Satoru</creatorcontrib><creatorcontrib>Kataoka, Hiromi</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Immunology Abstracts</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Natural Science Collection</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Biological Science Collection</collection><collection>Research Library</collection><collection>Biological Science Database</collection><collection>Research Library (Corporate)</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Cancers</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ozeki, Takanori</au><au>Shimura, Takaya</au><au>Ozeki, Tomonori</au><au>Ebi, Masahide</au><au>Iwasaki, Hiroyasu</au><au>Kato, Hiroyuki</au><au>Inaguma, Shingo</au><au>Okuda, Yusuke</au><au>Katano, Takahito</au><au>Nishie, Hirotada</au><au>Takahashi, Satoru</au><au>Kataoka, Hiromi</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The Risk Analyses of Lymph Node Metastasis and Recurrence for Submucosal Invasive Colorectal Cancer: Novel Criteria to Skip Completion Surgery</atitle><jtitle>Cancers</jtitle><addtitle>Cancers (Basel)</addtitle><date>2022-02-06</date><risdate>2022</risdate><volume>14</volume><issue>3</issue><spage>822</spage><pages>822-</pages><issn>2072-6694</issn><eissn>2072-6694</eissn><abstract>(1) Background: Additional surgical resection after endoscopic resection (ER) is recommended for patients with submucosal invasive colorectal cancer (pT1 CRC) who have risk factors for lymph node metastasis (LNM) (high-risk pT1 CRC). This study aimed to identify risk factors for LNM and metastatic recurrence and to determine the low-risk population for whom additional surgery can be omitted among high-risk pT1 CRCs. (2) Methods: We retrospectively identified 404 patients with pT1 CRC who underwent ER or surgery, and patients were divided into three groups: low-risk (
= 79); high-risk pT1 with ER (
= 40); and high-risk with surgery (
= 285). We also enrolled another 64 patients with high-risk pT1 CRC in an independent validation cohort. (3) Results: In the high-risk with surgery group, LNM was seen in 11.2%, and vascular and lymphatic invasions were significantly independent risk factors for LNM on multivariate analysis. No LNMs were observed in pT1 CRCs with a negative vertical margin and SM invasion depth ≤2000 µm that had no other risk factors except for budding. Five patients developed metastatic recurrence in the high-risk with surgery group, and rectal cancer and undifferentiated histology were significantly independent risk factors for poor relapse-free survival. No LNM or recurrent cases were seen in high-risk pT1 CRCs that met these criteria: differentiated adenocarcinoma, no lymphovascular invasion, colon cancer, SM invasion depth ≤2000 μm, and a negative vertical margin, which were validated in an independent validation cohort. (4) Conclusions: Completion surgery may be skipped for high-risk pT1 CRCs that meet our proposed criteria.</abstract><cop>Switzerland</cop><pub>MDPI AG</pub><pmid>35159088</pmid><doi>10.3390/cancers14030822</doi><orcidid>https://orcid.org/0000-0002-5888-6217</orcidid><orcidid>https://orcid.org/0000-0002-8139-8158</orcidid><orcidid>https://orcid.org/0000-0001-9491-0723</orcidid><orcidid>https://orcid.org/0000-0002-1451-8500</orcidid><orcidid>https://orcid.org/0000-0001-9507-1714</orcidid><orcidid>https://orcid.org/0000-0002-6048-0021</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Adenocarcinoma Colon cancer Colorectal cancer Colorectal carcinoma Endoscopy Histology Invasiveness Lymph nodes Lymphatic system Metastases Metastasis Morphology Multivariate analysis Patients Rectum Risk factors Surgery Survival Tumors |
| title | The Risk Analyses of Lymph Node Metastasis and Recurrence for Submucosal Invasive Colorectal Cancer: Novel Criteria to Skip Completion Surgery |
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