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DOI: 10.1055/s-0041-1724339
Deep Submucosal Invasion as Independent Risk Factor or Lymph Node Metastasis In T1 Colorectal Cancer: a Systematic Review and Meta-Analysis
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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Publikationsverlauf
Artikel online veröffentlicht:
19. März 2021
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