scholarly journals Composite Scoring System and Optimal Tumor Budding Cut-Off Number for Estimating Lymph Node Metastasis in Submucosal Colorectal Cancer

2021 ◽  
Author(s):  
Jeong-ki Kim ◽  
Ye-Young Rhee ◽  
Jeong Mo Bae ◽  
Jung Ho Kim ◽  
Seong-Joon Koh ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Risk Factors ◽  
Lymph Node ◽  
Venous Invasion ◽  
Tumor Budding ◽  
Multivariate Models ◽  
Histological Differentiation ◽  
Independent Risk Factors ◽  
Optimal Tumor ◽  
Submucosal Colorectal Cancer

Abstract Background Tumor budding is associated with lymph node (LN) metastasis in submucosal colorectal cancer (CRC). However, the rate of LN metastasis associated with the number of tumor buds is unknown. Here, we determined the optimal tumor budding cut-off number and developed a composite scoring system (CSS) for estimating LN metastasis of submucosal CRC. Methods In total, 395 patients with histologically confirmed T1N0–2M0 CRC were evaluated. The clinicopathological characteristics were subjected to univariate and multivariate analyses. The Akaike information criterion (AIC) values of the multivariate models were evaluated to identify the optimal cut-off number. A CSS for LN metastasis was developed using independent risk factors. Results The prevalence of LN metastasis was 13.2%. Histological differentiation, lymphatic or venous invasion, and tumor budding were associated with LN metastasis in univariate analyses. In multivariate models adjusted for histological differentiation and lymphatic or venous invasion, the AIC value was lowest for five tumor buds. Unfavorable differentiation (odds ratio [OR], 8.16; 95% confidence interval [CI], 1.80–36.89), lymphatic or venous invasion (OR, 5.91; 95% CI, 2.91–11.97), and five or more tumor buds (OR, 3.01; 95% CI, 1.21–7.69) were independent risk factors. In a CSS using these three risk factors, the rates of LN metastasis were 5.6%, 15.5%, 31.0%, and 52.4% for total composite scores of 0, 1, 2, and ≥ 3, respectively. Conclusions For the estimation of LN metastasis in submucosal CRC, the optimal tumor budding cut-off number was five. Our CSS can be utilized to estimate LN metastasis.

A real world analysis of recurrence risk factors for early colorectal cancer T1 treated with standard endoscopic resection.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 575-575
Author(s):  
Clara Martinez Vila ◽  
Carles Pericay ◽  
Helena Oliveres ◽  
Paula Ribera Fernandez ◽  
Maria Marin Alcala ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lymph Node ◽  
Endoscopic Resection ◽  
Perineural Invasion ◽  
Positive Margin ◽  
Early Colorectal Cancer ◽  
Histological Differentiation ◽  
Additional Surgery ◽  
Independent Risk Factors ◽  
Risk Of Relapse

575 Background: Currently, endoscopic resection of early colorectal cancer (ECC) defined as carcinoma with invasion limited to the mucosa (Tis), and submucosa (T1) is possible due to advances in instrumentation. However, when tumor invades submucosal layer, lymph node dissemination is present in 16.2% of cases, requiring additional surgery and limfadenectomy. Risk factors for lymph node dissemination and independent for relapse have been previously described in literature. Methods: We performed a retrospective analysis of all patients with colorectal T1 tumors, treated at our center with endoscopic resection and some with additional surgery between 2006 and 2017. Stadistical analysis was perfomed with IBM SPSS Statistics 24.0. Results: 159 patients (p) were treated with endoscopic resection, 56.6% (90p) underwent additional surgery. Mean age was 68.74 years and 69.9% (111p) were male. Endoscopic resection: negative margins 87.6%, vascular 3.1%, lymphatic 2.5% and perineural invasion 3.8%, high degree of histological differentiation 1.3%. Surgical resection: negative margins 100%, lymph node spread 8.8%. In a mean follow-up of 23.36 months since endoscopic treatment, 13 patients had relapsed. Risk of relapse did not differ between patients who received additional surgery and those who only underwent endoscopic resection (p = 0.791). On the other hand, lymph node dissemination (p = 0.007) and a positive margin (p = 0.01) were independent risk factors for risk of relapse. Vascular, lymphatic and perineural invasion, nor degree of histological differentation were stadistically significant. However, there was a positive association between lymph node dissemination and lymphatic (p = 0.07), vascular (p = 0.007) and perineural (p = 0.001) invasion and also degree of histological differentiation (p = 0.000). Conclusions: In our study, relapse rate was under 10% in eleven years. The only independent risk factors for relapse were a positive margin and lymph node dissemination. Perineural, vascular and lymphatic invasion obtained from polypectomy sample, could infer the probability of positive lymph nodes and indirectly be an indicator for risk of relapse.

Risk factors for lymph node metastasis in submucosally invasive colorectal cancer.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 542-542
Author(s):  
Liyong Huang ◽  
Xinxiang Li ◽  
Sanjun Cai
Keyword(s):  
Colorectal Cancer ◽  
Risk Factors ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Growth Pattern ◽  
Lymphovascular Invasion ◽  
Invasive Front ◽  
Node Metastasis ◽  
Independent Risk Factors ◽  
Histopathological Type

542 Background: The aim of this study was to identify risk factors for lymph node metastasis (LNM) in submucosally invasive colorectal cancer (SICC) that might be used in selecting patients for local excision. Methods: Records were reviewed from consecutive patients who had undergone curative resection of SICC at the Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China, between 2006 and 2013. Clinical features such as age, gender, tumor size, and location were reviewed. Histopathologic examinations including tumor growth type, growth pattern at the invasive front, histopathological type, depth of tumor invasion, tumor budding, lymphovascular invasion, and neural invasion were performed. The expression of E-cadherin, p53, and Ki-67 were examined by immunohistochemistry. The association between the clinicopathologic factors and LNM was evaluated. Results: A total of 265 patients (140 men and 125 women) treated for SICC were included. The overall LNM rate was 12.8%. The incidence of LNM was significantly associated with growth pattern at the invasive front (p=0.028), tumor budding (p=0.006), histopathological type (p<0.001), and lymphovascular invasion (p<0.001). Other clinicopathologic and immunohistochemical factors were irrelevant to LNM. In multiple variable logistic analysis, histopathological type, and lymphovascular invasion were the two independent risk factors of LNM (p=0.015 and p=0.007, respectively). Conclusions: Histopathological type and lymphovascular invasion are significant independent risk factors for LNM in SICC. Careful selection for local excision in SICC should be considered.

scholarly journals Microenvironmental markers are correlated with lymph node metastasis in invasive submucosal colorectal cancer

2021 ◽  
Author(s):  
Tamotsu Sugai ◽  
Noriyuki Yamada ◽  
Mitsumasa Osakabe ◽  
Mai Hashimoto ◽  
Noriyuki Uesugi ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Node Metastasis ◽  
Submucosal Colorectal Cancer

scholarly journals The Relationship Between Tumor Budding, Tumor Microenvironment, and Survival in Patients with Primary Operable Colorectal Cancer

2019 ◽  
Vol 26 (13) ◽  
pp. 4397-4404 ◽  
Author(s):  
Hester C. van Wyk ◽  
Antonia Roseweir ◽  
Peter Alexander ◽  
James H. Park ◽  
Paul G. Horgan ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Tumor Microenvironment ◽  
Evaluation Method ◽  
Venous Invasion ◽  
Staging System ◽  
Consensus Conference ◽  
Tumor Budding ◽  
Inflammatory Cell Infiltrate ◽  
Cancer Specific Survival ◽  
The Relationship

Abstract Background Tumor budding is an independent prognostic factor in colorectal cancer (CRC) and has recently been well-defined by the International Tumour Budding Consensus Conference (ITBCC). Objective The aim of the present study was to use the ITBCC budding evaluation method to examine the relationship between tumor budding, tumor factors, tumor microenvironment, and survival in patients with primary operable CRC. Methods Hematoxylin and eosin-stained slides of 952 CRC patients diagnosed between 1997 and 2007 were evaluated for tumor budding according to the ITBCC criteria. The tumor microenvironment was evaluated using tumor stroma percentage (TSP) and Klintrup–Makinen (KM) grade to assess the tumor inflammatory cell infiltrate. Results High budding (n = 268, 28%) was significantly associated with TNM stage (p < 0.001), competent mismatch repair (MMR; p < 0.05), venous invasion (p < 0.001), weak KM grade (p < 0.001), high TSP (p < 0.001), and reduced cancer-specific survival (CSS) (hazard ratio 8.68, 95% confidence interval 6.30–11.97; p < 0.001). Tumor budding effectively stratifies CSS stage T1 through to T4 (all p < 0.05) independent of associated factors. Conclusions Tumor budding effectively stratifies patients’ survival in primary operable CRC independent of other phenotypic features. In particular, the combination of T stage and budding should form the basis of a new staging system for primary operable CRC.

Tumor Budding and Pathological Differentiation Are Predictive Markers for Lymph Node Metastasis in T1 Colorectal Cancer

2006 ◽  
Vol 63 (5) ◽  
pp. AB216 ◽  
Author(s):  
Hitoshi Yamauchi ◽  
Kazutomo Togashi ◽  
Hiroshi Kawamura ◽  
Junichi Sasaki ◽  
Masaki Okada ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Predictive Markers ◽  
Tumor Budding ◽  
Node Metastasis ◽  
Pathological Differentiation ◽  
T1 Colorectal Cancer

Multifocal Papillary Thyroid Carcinoma，Hashimoto's Thyroiditis and Lymph Node Metastasis：A Retrospective Cohort Study

2021 ◽  
Author(s):  
Denghui Wang ◽  
Jiang Zhu ◽  
Chang Deng ◽  
Zhixin Yang ◽  
Daixing Hu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lymph Node ◽  
Lymph Node Metastases ◽  
Protective Factor ◽  
Roc Curves ◽  
Multivariate Logistic Regression ◽  
Lateral Lymph Node ◽  
Node Metastases ◽  
Independent Risk Factors ◽  
Central Lymph

Abstract Objective: Few studies have evaluated the influence of HT and Multifocality on central lymph node metastases(CLNM) and lateral lymph node metastases(LLNM) of PTC. The present study focused on risk factors for lymph node metastasis in PTC according to the presence of HT or multifocality. Materials and methods:1413 patients were identified.The relationship between HT or multifocality and lymph nodemetastasis was analyzed by univariate and multivariate logistic regression, ROC curves were constructed to show the predictive effect of each variable on the target outcome.Results: The PTCs with HT were more likely to be multifocal.(40.0% versus 17.5%,P ＜0.001). Compared to MPTC without HT, MPTC with HT showed a lower number of metastatic CLNs and LLNs (P < 0.05). HT was identifified as an independent protective factor for CLNM in all PTC patients (OR, 0.480; 95% CI, 0.359-0.643; P< .001) and in MPTC patients (OR, 0.094; 95% CI, 0.044-0.204; P < 0.001), the multicocality was independent risk factors for CLNM(OR, 2.316; 95% CI, 1.667-3.217; P< 0.001) and LLNM(OR, 2.004; 95% CI, 1.469-2.733; P< 0.001).The variables concluded HT or MPTC were screened to predict CLNM in all patients, CLNM in patients with MPTC and LLNM in all patients (AUCs: 0.731, 0.843 and 0.696, respectively, P < 0.0001). The two type of diseases existed concurrently may result in the decrease of CLNM and LLNM, AUCs of ROC to predict CLNM and LLNM are 0.696 and 0.63(P<0.0001). Conclusions: Our study identified multifocality as an independent risk factor predicting CLNM and LLNM in PTC patients. HT was proven to be a protective factor that reduced the CLNM risk in all patients and in patients with MPTC. The existence of both type of diseases can result in the reduction of CLNM and LLNM.

scholarly journals Pure Well-Differentiated Adenocarcinoma Is a Safe Factor for Lymph Node Metastasis in T1 and T2 Colorectal Cancer: A Pilot Study

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Naohisa Yoshida ◽  
Masayoshi Nakanishi ◽  
Ken Inoue ◽  
Ritsu Yasuda ◽  
Ryohei Hirose ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Venous Invasion ◽  
Lymphatic Invasion ◽  
Clinicopathological Factors ◽  
Node Metastasis ◽  
Kappa Value ◽  
T1 And T2 ◽  
Well Differentiated

Background and Aims. Various risk factors for lymph node metastasis (LNM) have been reported in colorectal T1 cancers. However, the factors available are insufficient for predicting LNM. We therefore investigated the utility of the new histological factor “pure well-differentiated adenocarcinoma” (PWDA) as a safe factor for predicting LNM in T1 and T2 cancers. Materials and Methods. We reviewed 115 T2 cancers and 202 T1 cancers in patients who underwent surgical resection in our center. We investigated the rates of LNM among various clinicopathological factors, including PWDA. PWDA was defined as a lesion comprising only well-differentiated adenocarcinoma. The consistency of the diagnosis of PWDA was evaluated among two pathologists. In addition, 72 T1 cancers with LNM from 8 related hospitals over 10 years (2008–2017) were also analyzed. Results. The rates of LNM and PWDA were 23.5% and 20.0%, respectively, in T2 cancers. Significant differences were noted between patients with and without LNM regarding lymphatic invasion (81.5% vs. 36.4%, p<0.001), poor histology (51.9% vs. 19.3%, p=0.008), and PWDA (3.7% vs. 25.0%, p=0.015). The rates of LNM and PWDA were 8.4% and 36.1%, respectively, in T1 cancers. Regarding the 73 PWDA cases and 129 non-PWDA cases, the rates of LNM were 0.0% and 13.2%, respectively (p<0.001). Among the 97 cases with lymphatic or venous invasion, the rates of LNM in 29 PWDA cases and 68 non-PWDA were 0% and 14.7%, respectively (p=0.029). The agreement of the two pathologists for the diagnosis of PWDA was acceptable (kappa value > 0.5). A multicenter review showed no cases of PWDA among 72 T1 cancers with LNM. Conclusions. PWDA is considered to be a safe factor for LNM in T1 cancer.

scholarly journals Examination of main lymph node (No.253) metastasis in left colorectal cancer: A retrospective analysis of a single-institution cohort

2021 ◽  
Author(s):  
Takefumi Yoshida ◽  
Fumihiko Fujita ◽  
Dai Shida ◽  
Kenichi Koushi ◽  
Kenji Fujiyoshi ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Risk Factors ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Poor Prognosis ◽  
Advanced Colorectal Cancer ◽  
D3 Lymphadenectomy ◽  
Positive Group ◽  
Factors Associated

Abstract Background. The extent of lymph node dissection in advanced colorectal cancer varies according to regional guidelines. D3 lymphadenectomy is routinely performed in Japan but is associated with several risk factors. Metastases of the main lymph nodes (No.253 lymph nodes), which are located at the root of the inferior mesenteric artery, are rare in left-sided colorectal cancer. Tumor depth (T4) is an identifier of No.253 lymph node metastasis (LNM) risk, but other risk factors associated with No.253 LNM are unclear. This study was undertaken to investigate the frequency of No.253 LNM and to identify other clinicopathological risk factors associated with No.253 LNM in left-sided colorectal cancer. In this study, we aimed to evaluate the clinical benefit of routine D3 lymphadenectomy in surgically treated advanced colorectal cancer. Methods. A retrospective database of patients with colorectal cancer who underwent D3 dissection and R0 resection at Kurume University Hospital from 1978 to 2017 was constructed and used to search for the frequency and risk factors of No.253 LNM to investigate long-term prognosis. Clinicopathological factors associated with No.253 LNM, including age, sex, tumor location, T stage, tumor diameter, carcinoembryonic antigen levels, and various dissected lymph nodes, were analyzed. Results. Among 1,614 consecutive patients, No.253 LNM was observed in 23 cases (1.4%). The presence of three or more regional LNMs was an independent risk factor for No.253 LNM (odds ratio: 26.8). The 5-year overall survival rate was 49.1% in the No.253 LNM-positive group and 78.4% in the No.253 LNM-negative group (p=0.002). Conclusion. In left-sided colorectal cancer, No.253 LNM was a poor prognosis factor, and three or more regional LNMs were a risk factor for No.253 LNM. The No.253 LNM-positive group had a poor prognosis, but there are cases of long-term survival, with a 5-year survival rate of 49%. D3 lymphadenectomy is suitable when three or more metastatic LNs are identified prior to surgery.

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