Please use this identifier to cite or link to this item: https://doi.org/10.1053/j.gastro.2022.04.010
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dc.titleDeep Submucosal Invasion Is Not an Independent Risk Factor for Lymph Node Metastasis in T1 Colorectal Cancer: A Meta-Analysis
dc.contributor.authorZwager, LW
dc.contributor.authorBastiaansen, BAJ
dc.contributor.authorMontazeri, NSM
dc.contributor.authorHompes, R
dc.contributor.authorBarresi, V
dc.contributor.authorIchimasa, K
dc.contributor.authorKawachi, H
dc.contributor.authorMachado, I
dc.contributor.authorMasaki, T
dc.contributor.authorSheng, W
dc.contributor.authorTanaka, S
dc.contributor.authorTogashi, K
dc.contributor.authorYasue, C
dc.contributor.authorFockens, P
dc.contributor.authorMoons, LMG
dc.contributor.authorDekker, E
dc.date.accessioned2023-02-10T01:36:15Z
dc.date.available2023-02-10T01:36:15Z
dc.date.issued2022-07-01
dc.identifier.citationZwager, 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
dc.identifier.issn00165085
dc.identifier.issn15280012
dc.identifier.urihttps://scholarbank.nus.edu.sg/handle/10635/237020
dc.description.abstractBackground & 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.
dc.publisherElsevier BV
dc.sourceElements
dc.subjectDeep Submucosal Invasion
dc.subjectLymph Node Metastasis
dc.subjectRisk Stratification
dc.subjectT1 Colorectal Cancer
dc.subjectColorectal Neoplasms
dc.subjectHumans
dc.subjectIncidence
dc.subjectLymph Node Excision
dc.subjectLymph Nodes
dc.subjectLymphatic Metastasis
dc.subjectNeoplasm Invasiveness
dc.subjectRetrospective Studies
dc.subjectRisk Factors
dc.subjectStomach Neoplasms
dc.typeArticle
dc.date.updated2023-02-09T08:45:09Z
dc.contributor.departmentMEDICINE
dc.description.doi10.1053/j.gastro.2022.04.010
dc.description.sourcetitleGastroenterology
dc.description.volume163
dc.description.issue1
dc.description.page174-189
dc.published.statePublished
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