Abstract
Objective: The purpose of this study was to identify predictive factors for lymph node metastasis (LNM) in pT1 stage colorectal cancer (CRC) patients. Methods: From the Surveillance, Epidemiology, and End Results (SEER) database, 2,697 consecutive pT1 stage patients who underwent surgical resection were retrospectively reviewed. Predictive factors for LNM were identified by the univariate and multivariate logistic regression analysis. The Kaplan-Meier curves and multivariate Cox regression analysis were used to evaluate the relationships between LNM and overall survival (OS) as well as cancer specific survival (CSS) of pT1 stage CRC patients. Results: The prevalence of LNM in pT1 stage CRC patients was 15.2% (410/2,697). Patient age <60 years (OR:1.869, 95% CI: 1.505–2.321, p < 0.001), poorly differentiated or mucinous or signet ring cell adenocarcinoma (OR:2.075, 95% CI: 1.584–2.717, p < 0.001), elevated carcinoembryonic antigen (CEA) level (OR:1.343, 95% CI: 1.022–1.763, p = 0.033) and perineural invasion (PNI) (OR:6.212, 95% CI: 3.502–11.017, p < 0.001) were significantly associated with LNM in pT1 stage patients. The survival analysis demonstrated that pT1 stage patients with LNM had a worse OS (5-year OS: 82.2% vs 88.7%, p = 0.020) and CSS (5-year CSS: 74.9% vs 81.5%, p = 0.041) than those without lymph node metastasis. Lymph node metastasis was an independent predictor of poor OS (HR: 1.543, 95% CI: 1.156–2.060, p = 0.003) and CSS (HR: 1.614, 95% CI: 1.121–2.324, p = 0.010) for pT1 stage colorectal cancer patients. Conclusion: Age, differentiation type, CEA level and perineural invasion were independent predictive factors for LNM in pT1 stage CRC patients. These findings might provide further risk stratification for pT1 stage patients and help clinicians identify high-risk individuals.
Highlights
Colorectal cancer (CRC) is one of the most prevalent malignant tumors and a major cause of cancer-related mortality in both Eastern and Western populations [1,2]
Patient age
The survival analysis demonstrated that pT1 stage patients with LNM had a worse overall survival (OS) (5-year OS: 82.2% vs 88.7%, p = 0.020) and cancer specific survival (CSS) (5-year CSS: 74.9% vs 81.5%, p = 0.041) than those without lymph node metastasis
Summary
Colorectal cancer (CRC) is one of the most prevalent malignant tumors and a major cause of cancer-related mortality in both Eastern and Western populations [1,2]. Endoscopic resection has become an alternative treatment method for submucosal invasive (pT1 stage) colorectal cancer patients [3,4], the potential risk of lymph node metastasis is still an important clinical consideration. It has been demonstrated that lymphovascular invasion, poorly differentiated adenocarcinoma or mucinous or signet-ring cell carcinoma, deep submucosal invasion (≥1,000 μm) and tumor budding were independent predictive factors for lymph node metastasis in pT1 stage colorectal cancer patients [5–8]. According to current treatment guidelines [9,10], patients with any of these risk factors were recommended to receive additional surgical treatment with lymph node dissection after endoscopic resection. To reduce the possibility of additional surgery, the accurate prediction of lymph node metastasis is crucial to determine the candidate for endoscopic resection. Further risk assessment for lymph node metastasis in pT1 stage colorectal cancer patients was warranted to determine the suitable treatment strategy
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