Please use this identifier to cite or link to this item: https://doi.org/10.1053/j.gastro.2022.04.010
Title: Deep Submucosal Invasion Is Not an Independent Risk Factor for Lymph Node Metastasis in T1 Colorectal Cancer: A Meta-Analysis
Authors: Zwager, LW
Bastiaansen, BAJ
Montazeri, NSM
Hompes, R
Barresi, V
Ichimasa, K 
Kawachi, H
Machado, I
Masaki, T
Sheng, W
Tanaka, S
Togashi, K
Yasue, C
Fockens, P
Moons, LMG
Dekker, E
Keywords: Deep Submucosal Invasion
Lymph Node Metastasis
Risk Stratification
T1 Colorectal Cancer
Colorectal Neoplasms
Humans
Incidence
Lymph Node Excision
Lymph Nodes
Lymphatic Metastasis
Neoplasm Invasiveness
Retrospective Studies
Risk Factors
Stomach Neoplasms
Issue Date: 1-Jul-2022
Publisher: Elsevier BV
Citation: Zwager, LW, Bastiaansen, BAJ, Montazeri, NSM, Hompes, R, Barresi, V, Ichimasa, K, Kawachi, H, Machado, I, Masaki, T, Sheng, W, Tanaka, S, Togashi, K, Yasue, C, Fockens, P, Moons, LMG, Dekker, E (2022-07-01). Deep Submucosal Invasion Is Not an Independent Risk Factor for Lymph Node Metastasis in T1 Colorectal Cancer: A Meta-Analysis. Gastroenterology 163 (1) : 174-189. ScholarBank@NUS Repository. https://doi.org/10.1053/j.gastro.2022.04.010
Abstract: Background & Aims: Deep submucosal invasion (DSI) is considered a key risk factor for lymph node metastasis (LNM) and important criterion to recommend surgery in T1 colorectal cancer. However, metastatic risk for DSI is shown to be low in the absence of other histologic risk factors. This meta-analysis determines the independent risk of DSI for LNM. Methods: Suitable studies were included to establish LNM risk for DSI in univariable analysis. To assess DSI as independent risk factor, studies were eligible if risk factors (eg, DSI, poor differentiation, lymphovascular invasion, and high-grade tumor budding) were simultaneously included in multivariable analysis or LNM rate of DSI was described in absence of poor differentiation, lymphovascular invasion, and high-grade tumor budding. Odds ratios (OR) and 95% CIs were calculated. Results: Sixty-seven studies (21,238 patients) were included. Overall LNM rate was 11.2% and significantly higher for DSI-positive cancers (OR, 2.58; 95% CI, 2.10–3.18). Eight studies (3621 patients) were included in multivariable meta-analysis and did not weigh DSI as a significant predictor for LNM (OR, 1.73; 95% CI, 0.96–3.12). As opposed to a significant association between LNM and poor differentiation (OR, 2.14; 95% CI, 1.39–3.28), high-grade tumor budding (OR, 2.83; 95% CI, 2.06–3.88), and lymphovascular invasion (OR, 3.16; 95% CI, 1.88–5.33). Eight studies (1146 patients) analyzed DSI as solitary risk factor; absolute risk of LNM was 2.6% and pooled incidence rate was 2.83 (95% CI, 1.66–4.78). Conclusions: DSI is not a strong independent predictor for LNM and should be reconsidered as a sole indicator for oncologic surgery. The expanding armamentarium for local excision as first-line treatment prompts serious consideration in amenable cases to tailor T1 colorectal cancer management.
Source Title: Gastroenterology
URI: https://scholarbank.nus.edu.sg/handle/10635/237020
ISSN: 00165085
15280012
DOI: 10.1053/j.gastro.2022.04.010
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