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Lymphovascular Infiltration, Not Depth of Invasion, is the Critical Risk Factor of Metastases in Early Colorectal Cancer : Retrospective Population-based Cohort Study on Prospectively Collected Data, including Validation

Ronnow, Carl Fredrik LU ; Arthursson, Victoria LU orcid ; Toth, Ervin LU ; Krarup, Peter Martin ; Syk, Ingvar LU and Thorlacius, Henrik LU (2022) In Annals of Surgery 275(1). p.148-154
Abstract

Objective: To identify clinical and histopathological risk factors of LNM in T1 CRC. Summary of Background Data: The requisite of additional surgery after locally resected T1 CRC is dependent on the risk of LNM. Depth of submucosal invasion is used as a key predictor of lymphatic metastases although data are conflicting on its actual impact. Methods: Retrospective population-based cohort study on prospectively collected data on all patients with T1 CRC undergoing surgical resection in Sweden, 2009-2017 and Denmark 2016-2018. The Danish cohort was used for validation. Potential risk factors of LNM investigated were; age, sex, tumor location, submucosal invasion, grade of differentiation, mucinous subtype, lymphovascular, and perineural... (More)

Objective: To identify clinical and histopathological risk factors of LNM in T1 CRC. Summary of Background Data: The requisite of additional surgery after locally resected T1 CRC is dependent on the risk of LNM. Depth of submucosal invasion is used as a key predictor of lymphatic metastases although data are conflicting on its actual impact. Methods: Retrospective population-based cohort study on prospectively collected data on all patients with T1 CRC undergoing surgical resection in Sweden, 2009-2017 and Denmark 2016-2018. The Danish cohort was used for validation. Potential risk factors of LNM investigated were; age, sex, tumor location, submucosal invasion, grade of differentiation, mucinous subtype, lymphovascular, and perineural invasion. Results: One hundred fifty out of the 1439 included patients (10%) had LNM. LVI (P < 0.001), perineural invasion (P < 0.001), mucinous subtype (P = 0.006), and age <60 years (P < 0.001) were identified as independent risk factors whereas deep submucosal invasion was only a dependent (P = 0.025) risk factor and not significant in multivariate analysis (P = 0.075). The incidence ofLNMwas 51/882 (6%) in absence of the independent risk factors. The Danish validation cohort, confirmed our findings regarding the role of submucosal invasion, LVI, and age. Conclusions: This is a large study on LNM in T1 CRC, including validation, showing that LVI and perineural invasion, mucinous subtype, and low age constitute independent risk factors, whereas depth of submucosal invasion is not an independent risk factor of LNM. Thus, our findings provide a useful basis for management of patients after local excision of early CRC.

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author
; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Colorectal cancer, Endoscopic resection, Lymph node metastases
in
Annals of Surgery
volume
275
issue
1
pages
148 - 154
publisher
Lippincott Williams & Wilkins
external identifiers
  • pmid:32187031
  • scopus:85122320932
ISSN
0003-4932
DOI
10.1097/SLA.0000000000003854
language
English
LU publication?
yes
additional info
Publisher Copyright: © 2022 Lippincott Williams and Wilkins. All rights reserved.
id
85186507-b5ba-484e-b29a-0eb490c3ffb7
date added to LUP
2022-02-24 15:25:01
date last changed
2025-03-09 21:26:06
@article{85186507-b5ba-484e-b29a-0eb490c3ffb7,
  abstract     = {{<p>Objective: To identify clinical and histopathological risk factors of LNM in T1 CRC. Summary of Background Data: The requisite of additional surgery after locally resected T1 CRC is dependent on the risk of LNM. Depth of submucosal invasion is used as a key predictor of lymphatic metastases although data are conflicting on its actual impact. Methods: Retrospective population-based cohort study on prospectively collected data on all patients with T1 CRC undergoing surgical resection in Sweden, 2009-2017 and Denmark 2016-2018. The Danish cohort was used for validation. Potential risk factors of LNM investigated were; age, sex, tumor location, submucosal invasion, grade of differentiation, mucinous subtype, lymphovascular, and perineural invasion. Results: One hundred fifty out of the 1439 included patients (10%) had LNM. LVI (P &lt; 0.001), perineural invasion (P &lt; 0.001), mucinous subtype (P = 0.006), and age &lt;60 years (P &lt; 0.001) were identified as independent risk factors whereas deep submucosal invasion was only a dependent (P = 0.025) risk factor and not significant in multivariate analysis (P = 0.075). The incidence ofLNMwas 51/882 (6%) in absence of the independent risk factors. The Danish validation cohort, confirmed our findings regarding the role of submucosal invasion, LVI, and age. Conclusions: This is a large study on LNM in T1 CRC, including validation, showing that LVI and perineural invasion, mucinous subtype, and low age constitute independent risk factors, whereas depth of submucosal invasion is not an independent risk factor of LNM. Thus, our findings provide a useful basis for management of patients after local excision of early CRC.</p>}},
  author       = {{Ronnow, Carl Fredrik and Arthursson, Victoria and Toth, Ervin and Krarup, Peter Martin and Syk, Ingvar and Thorlacius, Henrik}},
  issn         = {{0003-4932}},
  keywords     = {{Colorectal cancer; Endoscopic resection; Lymph node metastases}},
  language     = {{eng}},
  month        = {{01}},
  number       = {{1}},
  pages        = {{148--154}},
  publisher    = {{Lippincott Williams & Wilkins}},
  series       = {{Annals of Surgery}},
  title        = {{Lymphovascular Infiltration, Not Depth of Invasion, is the Critical Risk Factor of Metastases in Early Colorectal Cancer : Retrospective Population-based Cohort Study on Prospectively Collected Data, including Validation}},
  url          = {{http://dx.doi.org/10.1097/SLA.0000000000003854}},
  doi          = {{10.1097/SLA.0000000000003854}},
  volume       = {{275}},
  year         = {{2022}},
}