Pathological predictors for lymph node metastasis in T1 colorectal cancer

PurposeTo clarify pathological predictor for lymph node metastasis in T1 colorectal cancer.MethodsOne hundred and sixty-four patients who underwent surgery for single T1 colorectal cancer were reviewed. The pathological differentiations of non-well differentiation, invasion depth (≥2 000 μm), lymphatic channel involvement, venous invasion, and tumor budding were selected as candidate predictors. Tumor budding was estimated according to the definition proposed by Ueno et al. (Gastroenterology 2004; 127:385–394). The lymph node status was set for the endpoint. Logistic regression model was applied to analyze the predictors.ResultsLymph node involvement was observed in 9.8%. The positive rates were 13.4% for the pathological differentiations of non-well differentiation, 51.8% for invasion depth (≥2 000 μm), 6.1% for lymphatic channel involvement, 8.5% for venous invasion, and 14.6% for tumor budding. The pathological differentiations of non-well differentiation (P < 0.001) and tumor budding (P = 0.002) were significantly associated with lymph node metastasis in multivariate analysis. When either two significant factors was adopted for the prediction of the lymph node metastasis, the sensitivity, specificity, positive predictive value, and negative predictive value were 94%, 82%, 36%, and 99%, respectively.ConclusionThe pathological differentiations of non-well differentiation and tumor budding are useful predictors for lymph node metastasis in T1 colorectal cancer.

[1]  L. Bégin,et al.  The care of patients with colorectal polyps that contain invasive adenocarcinoma. Endoscopic polypectomy or colectomy? , 1992, Cancer.

[2]  Shung-Haur Yang,et al.  Curative Resection of T1 Colorectal Carcinoma: Risk of Lymph Node Metastasis and Long-Term Prognosis , 2005, Diseases of the colon and rectum.

[3]  P. Netzer,et al.  Risk factor assessment of endoscopically removed malignant colorectal polyps , 1998, Gut.

[4]  Y. Atomi,et al.  Clinical utility of grading criteria for submucosal invasion in the prognosis of T1 colorectal carcinomas , 2003, Journal of Gastroenterology.

[5]  J. Silverman,et al.  Endoscopically removed malignant colorectal polyps: clinicopathologic correlations. , 1995, Gastroenterology.

[6]  K. Hase,et al.  Long-term results of curative resection of “minimally invasive” colorectal cancer , 1995, Diseases of the colon and rectum.

[7]  R. Nozaki,et al.  Management of early invasive colorectal cancer , 1995, Diseases of the colon and rectum.

[8]  M. Barten,et al.  Tumour budding as prognostic factor in stage I/II colorectal carcinoma , 2005, Histopathology.

[9]  Hidetaka Mochizuki,et al.  Risk factors for an adverse outcome in early invasive colorectal carcinoma. , 2004, Gastroenterology.

[10]  K. Hase,et al.  Prognostic value of tumor “budding” in patients with colorectal cancer , 1993, Diseases of the colon and rectum.

[11]  M. Sivak,et al.  When is endoscopic polypectomy adequate therapy for colonic polyps containing invasive carcinoma? , 1986, Gastroenterology.

[12]  J. Goldblum,et al.  Management and outcome of patients with invasive carcinoma arising in colorectal polyps. , 1995, Gastroenterology.

[13]  M. Morimatsu,et al.  An index for estimating the probability of lymph node metastasis in rectal cancers. Lymph node metastasis and the histopathology of actively invasive regions of cancer , 1989, Cancer.

[14]  M F Dixon,et al.  The Vienna classification of gastrointestinal epithelial neoplasia , 2000, Gut.

[15]  S. Ishiguro,et al.  New indication for endoscopic treatment of colorectal carcinoma with submucosal invasion , 2004, Journal of gastroenterology and hepatology.

[16]  C. R. Teixeira,et al.  Endoscopic treatment of submucosal invasive colorectal carcinoma with special reference to risk factors for lymph node metastasis , 1995, Journal of Gastroenterology.

[17]  Toshihide Kumamoto,et al.  Correlations between lymph node metastasis and depth of submucosal invasion in submucosal invasive colorectal carcinoma: a Japanese collaborative study , 2004, Journal of Gastroenterology.

[18]  H. Ueno,et al.  Tumour `budding' as an index to estimate the potential of aggressiveness in rectal cancer , 2002, Histopathology.

[19]  W. Richards,et al.  Patient management after endoscopic removal of the cancerous colon adenoma. , 1987, Annals of surgery.

[20]  N. Goldstein,et al.  Histologic features associated with lymph node metastasis in stage T1 and superficial T2 rectal adenocarcinomas in abdominoperineal resection specimens. Identifying a subset of patients for whom treatment with adjuvant therapy or completion abdominoperineal resection should be considered after local , 1999, American journal of clinical pathology.

[21]  Y. Atomi,et al.  Budding as a useful determinant of the optimal treatment for T1 rectal carcinomas. , 2003, Hepato-gastroenterology.

[22]  L. Burgart,et al.  Risk of Lymph Node Metastasis in T1 Carcinoma of the Colon and Rectum , 2002, Diseases of the colon and rectum.

[23]  K. Togashi,et al.  Predictive factors for lymph node metastasis in t1 stage colorectal Carcinomas , 2003, Diseases of the colon and rectum.

[24]  Jinnai Dennosuke,et al.  General rules for clinical and pathological studies on cancer of the colon, rectum and anus , 1983 .