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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 |
Appears in Collections: | Staff Publications Elements |
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