Predictors of Lymph Node Metastasis in T1 Colorectal Cancer in Young Patients: Results from a National Cancer Registry.

Daryl Ramai,Gianluca Tomasello,Jameel Singh,Michele Ghidini,Banreet Dhindsa,Antonio Facciorusso,Amaninder Dhaliwal,Barbara Galassi,Saurabh Chandan

doi:10.3390/jcm10235511

Abstract

The objective of this study is to fill the knowledge gap by examining predictors of lymph node metastasis (LNM) in young patients, less than 45 years, using a national cancer registry. Methods: Patients diagnosed with T1 colorectal cancer were identified in the Surveillance, Epidemiology, and End Results registry. In total, 692 patients with T1 colorectal cancer were identified. Most tumors occurred in white race (77.7%), between 40 and 44 years of age (49.4%), with grade III tumor differentiation (59.8%) and 1 to 1.9 cm size (32.2%), and were left-sided tumors (61.1%). The overall rate of LNM was 22.5% (n = 149). LNM was associated with tumor grade IV (undifferentiated) (odds ratio (OR) 2.94, CI: 1.06–8.12; p = 0.038), and increasing tumor size (1 cm–1.9 cm: OR 2.92, CI: 1.71–4.97, p < 0.001; 2.0 cm–2.9 cm: OR 2.00, CI: 1.05–3.77, p = 0.034; and ≥3.0 cm: OR 2.68, CI: 1.43–5.01, p = 0.002). Five-year cancer-specific survival for patients with LNM was 91% and for patients without LNM this was 98%. Adjusted cox proportion models showed that LNM was associated with a four times higher rate of mortality (hazard ratio (HR) 4.43, CI: 1.27–15.52, p = 0.020). In this population-based analysis of patients with T1 colorectal cancer, tumor size and grade were significant predictors of LNM.

Highlights

Colorectal cancer (CRC) is the third most diagnosed cancer around the world, with an incidence rate of 10.9% in men and 9.5% in women [1,2]
A T1 CRC lesion is defined as a primary tumor invading only the submucosal layer, a T2 lesion has grown into the muscularis propria, a T3 lesion has grown through the muscularis propria and into the subserosa, and a T4 lesion has grown into the surface of the visceral peritoneum or has grown into or attached to other organs or structures [2,3]
A total of 659,887 patients with colorectal cancer were identified of which 692 patients with stage T1 colorectal carcinoma were extracted (Figure 1)

Summary

Introduction

Colorectal cancer (CRC) is the third most diagnosed cancer around the world, with an incidence rate of 10.9% in men and 9.5% in women [1,2]. Increased surveillance of CRC has led to a decrease in incidence and mortality, and improvement in overall prognosis [3,4]. While prior reports have documented a decrease in the incidence of CRC in average risk adults, there is a growing incidence of CRC in younger patients under 44 years of age [5]. An estimated 37,148 newly diagnosed cases of CRC in young adults were documented between 1980 and 2016, with a growing incidence of 1.3% annually between 1996 and 2016 [6]. A T1 CRC lesion is defined as a primary tumor invading only the submucosal layer, a T2 lesion has grown into the muscularis propria, a T3 lesion has grown through the muscularis propria and into the subserosa, and a T4 lesion has grown into the surface of the visceral peritoneum or has grown into or attached to other organs or structures [2,3]

Objectives

Methods

Results

Discussion

Conclusion