Deep Submucosal Invasion Is Not an Independent Risk Factor for Lymph Node Metastasis in T1 Colorectal Cancer: A Meta-Analysis
Zwager, Liselotte W; Bastiaansen, Barbara A J; Montazeri, Nahid S M; Hompes, Roel; Barresi, Valeria; Ichimasa, Katsuro; Kawachi, Hiroshi; Machado, Isidro; Masaki, Tadahiko; Sheng, Weiqi; Tanaka, Shinji; Togashi, Kazutomo; Yasue, Chihiro; Fockens, Paul; Moons, Leon M G; Dekker, Evelien
(2022) Gastroenterology, volume 163, issue 1, pp. 174 - 189
(Article)
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
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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.
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Keywords: Colorectal Neoplasms/pathology, Humans, Incidence, Lymph Node Excision, Lymph Nodes/pathology, Lymphatic Metastasis/pathology, Neoplasm Invasiveness/pathology, Retrospective Studies, Risk Factors, Stomach Neoplasms/pathology, T1 Colorectal Cancer, Risk Stratification, Deep Submucosal Invasion, Lymph Node Metastasis, Gastroenterology, Hepatology, Meta-Analysis, Journal Article
ISSN: 0016-5085
Publisher: W.B. Saunders Ltd
Note: Funding Information: The authors thank F. S. van Etten-Jamaludin, clinical librarian, for assistance in performing the literature search used for this review. Data are available on reasonable request. Liselotte W. Zwager, MD (Conceptualization: Equal; Data curation: Lead; Methodology: Equal; Project administration: Lead; Writing – original draft: Equal; Writing – review & editing: Lead). Barbara A. J. Bastiaansen, MD (Conceptualization: Equal; Data curation: Equal; Investigation: Equal; Methodology: Equal; Supervision: Equal; Writing – original draft: Equal; Writing – review & editing: Lead). Nahid S. M. Montazeri, MS, PhD (Formal analysis: Lead; Methodology: Equal; Writing – review & editing: Equal). Roel Hompes, MD, PhD (Conceptualization: Equal; Writing – review & editing: Equal). Valeria Barresi, MD, PhD (Data curation: Supporting; Writing – review & editing: Equal). Katsuro Ichimasa, MD, PhD (Data curation: Supporting; Writing – review & editing: Equal). Hiroshi Kawachi, MD, PhD (Data curation: Supporting; Writing – review & editing: Equal). Isidro Machado, MD, PhD (Data curation: Supporting; Writing – review & editing: Equal). Tadahiko Masaki, MD, PhD (Data curation: Supporting; Writing – review & editing: Equal). Weiqi Sheng, MD, PhD (Data curation: Supporting; Writing – review & editing: Equal). Shinji Tanaka, MD, PhD (Data curation: Supporting; Writing – review & editing: Equal). Kazutomo Togashi, MD, PhD (Data curation: Supporting; Writing – review & editing: Equal). Chihiro Yasue, MD, PhD (Data curation: Supporting; Writing – review & editing: Equal). Paul Fockens, MD, PhD (Conceptualization: Equal; Writing – review & editing: Equal). Leon M. G. Moons, MD, PhD (Conceptualization: Equal; Writing – review & editing: Equal). Evelien Dekker, MD, PhD (Conceptualization: Equal; Data curation: Supporting; Investigation: Equal; Methodology: Supporting; Supervision: Lead; Writing – original draft: Supporting; Writing – review & editing: Lead). Conflicts of interest These authors disclose the following: Barbara A. J. Bastiaansen received a speakers’ fee from Olympus, Tillotts Pharma AG, and Ovesco Endoscopy AG. Roel Hompes received a research grant from Stryker, speakers’ fee from Medtronic, Johnson & Johnson, and Applied Medical. Paul Fockens reports personal fees from Cook, Ethicon, and Olympus, research support from Boston Scientific, outside the submitted work. Evelien Dekker has endoscopic equipment on loan from FujiFilm, received a research grant from FujiFilm, received a honorarium for consultancy from FujiFilm, Olympus, Tillots Pharma AG, GI Supply, CPP-FAP, and PAION, and a speakers' fee from Olympus, Roche and GI Supply. The remaining authors disclose no conflicts. Funding Information: Conflicts of interest These authors disclose the following: Barbara A. J. Bastiaansen received a speakers’ fee from Olympus, Tillotts Pharma AG, and Ovesco Endoscopy AG. Roel Hompes received a research grant from Stryker, speakers’ fee from Medtronic, Johnson & Johnson, and Applied Medical. Paul Fockens reports personal fees from Cook, Ethicon, and Olympus, research support from Boston Scientific, outside the submitted work. Evelien Dekker has endoscopic equipment on loan from FujiFilm, received a research grant from FujiFilm, received a honorarium for consultancy from FujiFilm, Olympus, Tillots Pharma AG, GI Supply, CPP-FAP, and PAION, and a speakers' fee from Olympus, Roche and GI Supply. The remaining authors disclose no conflicts. Publisher Copyright: © 2022 The Author(s)
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