Endoscopy 2021; 53(S 01): S34
DOI: 10.1055/s-0041-1724339
Abstracts | ESGE Days
ESGE Days 2021 Oral presentations
Friday, 26 March 2021 09:00 – 09:45 Endoscopic therapy for early (pT1) colorectal cancer Room 5

Deep Submucosal Invasion as Independent Risk Factor or Lymph Node Metastasis In T1 Colorectal Cancer: a Systematic Review and Meta-Analysis

LW Zwager
1   Amsterdam University Medical Center, Location Academic Medical Center, Amsterdam Cancer Center, University of Amsterdam, Department of Gastroenterology and Hepatology, Amsterdam, Netherlands
,
BAJ Bastiaansen
1   Amsterdam University Medical Center, Location Academic Medical Center, Amsterdam Cancer Center, University of Amsterdam, Department of Gastroenterology and Hepatology, Amsterdam, Netherlands
,
N Mostafavi
2   Amsterdam University Medical Center, Location Academic Medical Center, University of Amsterdam, Biostatistical Unit, Amsterdam, Netherlands
,
R Hompes
3   Amsterdam University Medical Center, Location Academic Medical Center, Amsterdam Cancer Center, University of Amsterdam, Department of Surgery, Amsterdam, Netherlands
,
V Barresi
4   University of Verona, Department of Diagnostics and Public Health, Verona, Italy
,
K Ichimasa
5   Digestive Disease Center, Showa University Northern Yokohama Hospital, Tsuzuki, Yokohama, Japan
,
H Kawachi
6   Cancer Institute Hospital, Japanese Foundation for Cancer Research, Department of Pathology, Tokyo, Japan
,
I Machado
7   Instituto Valenciano de Oncología, Pathology Department, Valencia, Spain
,
T Masaki
8   Kyorin University, Department of Surgery, Shinkawa, Mitaka City, Tokyo, Japan
,
W Sheng
9   Fudan University Shanghai Cancer Center, Department of Pathology, Shanghai, China
,
S Tanaka
10   Hiroshima University Hospital, Department of Endoscopy, Hiroshima, Japan
,
K Togashi
11   Aizu Medical Center Fukushima Medical University, Department of Coloproctology, Aizuwakamatsu, Fukushima, Japan
,
P Fockens
1   Amsterdam University Medical Center, Location Academic Medical Center, Amsterdam Cancer Center, University of Amsterdam, Department of Gastroenterology and Hepatology, Amsterdam, Netherlands
,
LMG Moons
12   Utrecht University Medical Center, Department of Gastroenterology and Hepatology, Utrecht, Netherlands
,
E Dekker
1   Amsterdam University Medical Center, Location Academic Medical Center, Amsterdam Cancer Center, University of Amsterdam, Department of Gastroenterology and Hepatology, Amsterdam, Netherlands
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    Aims Accurate risk estimation for lymph node metastasis (LNM) in T1 colorectal cancer (CRC) is critical to optimize further treatment. Multiple studies suggest that deep submucosal invasion (DSI) is not a strong predictor for LNM. Therefore, we conducted a systematic review and meta-analysis to determine whether DSI is an independent risk factor for LNM in T1 CRC.

    Methods A systematic search was performed from inception to January 2021. To establish the risk of DSI for LNM in univariate analysis, all suitable studies were included in meta-analysis. To determine whether DSI (≥1000µm or sm2-3) was an independent risk factor in relation to risk factors as poor differentiation (PD), lymphovascular invasion (LVI) and/or high-grade tumor budding (TB), studies were eligible if 1) DSI was described as only present high-risk factor or 2) the above-mentioned risk factors were simultaneously included in multivariate analysis. Odds ratios (OR) and 95 % confidence intervals (CI) were calculated through meta-analysis.

    Results 65 studies (21,076 patients) were included with overall LNM rate of 11.2 %. All studies analyzed the relationship between DSI and LNM in univariate analysis with a significantly higher LNM rate in the group with DSI (OR 2.59; 95 %CI 2.10-3.19). Seven studies (1080 patients) described DSI in absence of all other high-risk factors. The LNM-positivity rate was 2.6 % (n=28/1080) with an incidence rate of 2.71 (95 %CI 1.47 – 4.95). Eight studies (3612 patients) included DSI in multivariate analysis. DSI was not a significant predictor for LNM (OR 1.73; 95 %CI 0.96 – 3.12), compared to PD (OR 2.14; 95 %CI 1.39 – 3.28), TB (OR 2.83; 95 %CI 2.06 – 3.88) and LVI (OR 3.16; 95 %CI 1.88 – 5.33).

    Conclusion DSI is not an independent risk-factor for LNM. In DSI cancers, LNM-positivity rate is low (2.6 %) in absence of other risk factors. With the expanding spectrum of endoscopic resection methods, DSI should be reconsidered as strong indicator for oncologic surgery.

    Citation Zwager LW, Bastiaansen BAJ, Mostafavi N et al. OP80 DEEP SUBMUCOSAL INVASION AS INDEPENDENT RISK FACTOR FOR LYMPH NODE METASTASIS IN T1 COLORECTAL CANCER: A SYSTEMATIC REVIEW AND META-ANALYSIS. Endoscopy 2021; 53: S34.


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    Publication History

    Article published online:
    19 March 2021

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