Risk Factors for Predicting Lymph Node Metastasis in Submucosal Colorectal Cancer

Kurumi Tsuchihashi; Norikatsu Miyoshi; Shiki Fujino; Masatoshi Kitakaze; Masayuki Ohue; Katsuki Danno; Itsuko Nakamichi; Kenji Ohshima; Eiichi Morii; Mamoru Uemura; Yuichiro Doki; Hidetoshi Eguchi

doi:10.23922/jarc.2022-002

Risk Factors for Predicting Lymph Node Metastasis in Submucosal Colorectal Cancer

J Anus Rectum Colon. 2022 Jul 28;6(3):181-189. doi: 10.23922/jarc.2022-002. eCollection 2022.

Authors

Kurumi Tsuchihashi¹, Norikatsu Miyoshi^{1

2}, Shiki Fujino^{2

3}, Masatoshi Kitakaze¹, Masayuki Ohue⁴, Katsuki Danno^{2

3}, Itsuko Nakamichi⁵, Kenji Ohshima⁶, Eiichi Morii⁶, Mamoru Uemura¹, Yuichiro Doki¹, Hidetoshi Eguchi¹

Affiliations

¹ Department of Surgery, Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan.
² Department of Innovative Oncology Research and Regenerative Medicine, Osaka International Cancer Institute, Osaka, Japan.
³ Department of Surgery, Minoh City Hospital, Minoh, Japan.
⁴ Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan.
⁵ Department of Pathology, Minoh City Hospital, Minoh, Japan.
⁶ Department of Pathology, Graduate School of Medicine, Osaka University, Suita, Japan.

Abstract

Objectives: The cornerstone of treating colorectal cancer (CRC) is generally a surgical resection with lymph node (LN) dissection. The tools for predicting lymph node metastasis (LNM) in submucosal (SM) CRC are useful to avoid unnecessary surgical resection.

Methods: Retrospectively, we analyzed 526 consecutive patients with SM CRC who underwent surgical resection at the Osaka International Cancer Institute, Osaka University Hospital, and Minoh City Hospital, Japan, between 1984 and 2012. The Osaka International Cancer Institute group and the Osaka University Hospital group were randomly divided into a training set and a test set of 2:1. The prediction model was validated in Minoh City Hospital.

Results: We partitioned patients using three risk factors involved in the presence or absence of LNM in SM CRC: lymphatic invasion (Ly), budding grade (BD) and the depth of submucosal invasion (DSI) (cut-off value 2789 μm) that were significantly different in the multivariate analysis. As a result, a predictive model of "LNM <5%" when "Ly negative and DSI <2789 μm" was evaluated. We similarly partitioned by DSI 3000 μm as easy-to-evaluate values in clinical use. We developed the additional model for predicting LNM is 1.05%, that is, LNM <5%, when there are "Ly negative and DSI <3000 μm."

Conclusions: As a limitation, only patients who underwent surgical resection were included in this study. This predictive model could help clinicians and CRC patients decide on the additional surgery required after endoscopic resection.

Keywords: lymph node metastasis; partition; predictive model; submucosal colorectal cancer.