Risk factors of lymph node metastasis in T1 rectal cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

YE Zhou , WANG Mojin , BAI Lifen , ZHANG Peng , ZHUANG Hanxiang ,  ZHUANG Wen

Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding?author：

ZHUANG Wen, Email: zhuangwen1966@163.com

Keywords：

T1 rectal cancer; lymph node metastasis; risk factor; local resection

DOI：

10.7507/1007-9424.201803039

Video：

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Objective To explore risk factors of lymph node metastasis (LNM) in T1 rectal cancer. Methods The retrospective case-control study was conducted. The clinicopathologic data of 247 patients with T1 rectal cancer underwent radical resection were analyzed in the pathological database of the West China Hospital from January 2000 to December 2016, including the tumor size (maximum diameter), gross type, differentiation degree, histological type, lymph vascular infiltration, perineural infiltration, and carcinoma nodule. The univariate analysis and multivariate analysis were done using the Chi-square test and logistic regression model, respectively. Results The rate of LNM in the patients with T1 rectal cancer was 8.50% (21/247). No lymph metastasis was found in the well differentiated T1 rectal cancer. The results of the univariate analysis showed that the differentiation degree, histological type, and carcinoma nodule were related to the LNM in the T1 rectal cancer (P<0.050). The results of the multivariate analysis revealed that the poor differentiation, mucinous adenocarcinoma, signet-ring cell carcinoma, and carcinoma nodule were the independent risk factors of the LNM in the T1 rectal cancer (OR=9.75, P=0.006; OR=5.98, P=0.042; OR=8.33, P=0.017; OR=10.87, P=0.026). Conclusion In this large population dataset, poor differentiation, mucinous adenocarcinoma, signet-ring cell carcinoma, and carcinoma nodule are risk factors of LNM in T1 rectal cancer.

Citation： YE Zhou, WANG Mojin, BAI Lifen, ZHANG Peng, ZHUANG Hanxiang, ZHUANG Wen. Risk factors of lymph node metastasis in T1 rectal cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2018, 25(9): 1099-1102. doi: 10.7507/1007-9424.201803039 Copy

1.	Zenni GC, Abraham K, Harford FJ, et al. Characteristics of rectal carcinomas that predict the presence of lymph node metastases: implications for patient selection for local therapy. J Surg Oncol, 1998, 67(2): 99-103.
2.	Chok KS, Law WL. Prognostic factors affecting survival and recurrence of patients with pT1 and pT2 colorectal cancer. World J Surg, 2007, 31(7): 1485-1490.
3.	Baatrup G, Qvist N. Local resection of early rectal cancer. APMIS, 2014, 122(8): 715-722.
4.	Restivo A, Zorcolo L, D'Alia G, et al. Risk of complications and long-term functional alterations after local excision of rectal tumors with transanal endoscopic microsurgery (TEM). Int J Colorectal Dis, 2016, 31(2): 257-266.
5.	汪建平. 中低位直腸癌側方淋巴結清掃的爭議. 外科理論與實踐, 2010, 15(2): 108-110.
6.	陳鴻源, 李國新. 結直腸癌腸系膜血管根部淋巴結轉移的相關因素分析. 南方醫科大學, 2014.
7.	姚宏偉, 吳鴻偉, 劉蔭華. 美國癌癥聯合委員會第八版結直腸癌分期更新及其" 預后和預測”評價體系. 中華胃腸外科雜志, 2017, 20(1): 24-27.
8.	Monson JR, Weiser MR, Buie WD, et al. Practice parameters for the management of rectal cancer (revised). Dis Colon Rectum, 2013, 56(5): 535-550.
9.	Watanabe T, Muro K, Ajioka Y, et al. Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2016 for the treatment of colorectal cancer. Int J Clin Oncol, 2018, 23(1): 1-34.
10.	屠世良, 葉再元, 鄧高里, 等. 結直腸癌淋巴結轉移的規律及其影響因素. 中華胃腸外科雜志, 2007, 10(3): 257-260.
11.	Takano S, Kato J, Yamamoto H, et al. Identification of risk factors for lymph node metastasis of colorectal cancer. Hepatogastroenterology, 2007, 54(75): 746-750.
12.	Brunner W, Widmann B, Marti L, et al. Predictors for regional lymph node metastasis in T1 rectal cancer: a population-based SEER analysis. Surg Endosc, 2016, 30(10): 4405-4415.
13.	Kobayashi H, Mochizuki H, Kato T, et al. Is total mesorectal excision always necessary for T1–T2 lower rectal cancer? Ann Surg Oncol, 2010, 17(4): 973-980.
14.	Nash GM, Weiser MR, Guillem JG, et al. Long-term survival after transanal excision of T1 rectal cancer. Dis Colon Rectum, 2009, 52(4): 577-582.
15.	Bach SP, Hill J, Monson JR, et al. A predictive model for local recurrence after transanal endoscopic microsurgery for rectal cancer. Br J Surg, 2009, 96(3): 280-290.
16.	Greenberg JA, Shibata D, Herndon JE 2nd, et al. Local excision of distal rectal cancer: an update of cancer and leukemia group B 8984. Dis Colon Rectum, 2008, 51(8): 1185-1194.
17.	Saraste D, Gunnarsson U, Janson M. Predicting lymph node metastases in early rectal cancer. Eur J Cancer, 2013, 49(5): 1104-1108.
18.	Rasheed S, Bowley DM, Aziz O, et al. Can depth of tumour invasion predict lymph node positivity in patients undergoing resection for early rectal cancer? A comparative study between T1 and T2 cancers. Colorectal Dis, 2008, 10(3): 231-238.
19.	Lamont JP, McCarty TM, Digan RD, et al. Should locally excised T1 rectal cancer receive adjuvant chemoradiation? Am J Surg, 2000, 180(6): 402-405.
20.	Lezoche E, Guerrieri M, Paganini AM, et al. Long-term results in patients with T2-3 N0 distal rectal cancer undergoing radiotherapy before transanal endoscopic microsurgery. Br J Surg, 2005, 92(12): 1546-1552.
21.	Wentworth S, Russell GB, Tuner II, et al. Long-term results of local excision with and without chemoradiation for adenocarcinoma of the rectum. Clin Colorectal Cancer, 2005, 4(5): 332-335.
22.	Vallam KC, Desouza A, Bal M, et al. Adenocarcinoma of the rectum—A composite of three different subtypes with varying outcomes? Clin Colorectal Cancer, 2016, 15(2): e47-e52.
23.	Sung CO, Seo JW, Kim KM, et al. Clinical significance of signet-ring cells in colorectal mucinous adenocarcinoma. Mod Pathol, 2008, 21(12): 1533-1541.
24.	Hugen N, van de Velde CJ, de Wilt JH, et al. Metastatic pattern in colorectal cancer is strongly influenced by histological subtype. Ann Oncol, 2014, 25(3): 651-657.
25.	Chew MH, Yeo SA, Ng ZP, et al. Critical analysis of mucin and signet ring cell as prognostic factors in an Asian population of 2 764 sporadic colorectal cancers. Int J Colorectal Dis, 2010, 25(10): 1221-1229.
26.	Lo DS, Pollett A, Siu LL, et al. Prognostic significance of mesenteric tumor nodules in patients with stage Ⅲ colorectal cancer. Cancer, 2008, 112(1): 50-54.
27.	Nagtegaal ID, Quirke P. Colorectal tumour deposits in the mesorectum and pericolon; a critical review. Histopathology, 2007, 51(2): 141-149.
28.	Ueno H, Mochizuki H, Hashiguchi Y, et al. Extramural cancer deposits without nodal structure in colorectal cancer: optimal categorization for prognostic staging. Am J Clin Pathol, 2007, 127(2): 287-294.
29.	Meyer JE, Cohen SJ, Ruth KJ, et al. Young age increases risk of lymph node positivity in early-stage rectal cancer. J Natl Cancer Inst, 2016, 108(1).
30.	Aytac E, Gorgun E, Costedio MM, et al. Impact of tumor location on lymph node metastasis in T1 colorectal cancer. Langenbecks Arch Surg, 2016, 401(5): 627-632.

1. Zenni GC, Abraham K, Harford FJ, et al. Characteristics of rectal carcinomas that predict the presence of lymph node metastases: implications for patient selection for local therapy. J Surg Oncol, 1998, 67(2): 99-103.
2. Chok KS, Law WL. Prognostic factors affecting survival and recurrence of patients with pT1 and pT2 colorectal cancer. World J Surg, 2007, 31(7): 1485-1490.
3. Baatrup G, Qvist N. Local resection of early rectal cancer. APMIS, 2014, 122(8): 715-722.
4. Restivo A, Zorcolo L, D'Alia G, et al. Risk of complications and long-term functional alterations after local excision of rectal tumors with transanal endoscopic microsurgery (TEM). Int J Colorectal Dis, 2016, 31(2): 257-266.
5. 汪建平. 中低位直腸癌側方淋巴結清掃的爭議. 外科理論與實踐, 2010, 15(2): 108-110.
6. 陳鴻源, 李國新. 結直腸癌腸系膜血管根部淋巴結轉移的相關因素分析. 南方醫科大學, 2014.
7. 姚宏偉, 吳鴻偉, 劉蔭華. 美國癌癥聯合委員會第八版結直腸癌分期更新及其" 預后和預測”評價體系. 中華胃腸外科雜志, 2017, 20(1): 24-27.
8. Monson JR, Weiser MR, Buie WD, et al. Practice parameters for the management of rectal cancer (revised). Dis Colon Rectum, 2013, 56(5): 535-550.
9. Watanabe T, Muro K, Ajioka Y, et al. Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2016 for the treatment of colorectal cancer. Int J Clin Oncol, 2018, 23(1): 1-34.
10. 屠世良, 葉再元, 鄧高里, 等. 結直腸癌淋巴結轉移的規律及其影響因素. 中華胃腸外科雜志, 2007, 10(3): 257-260.
11. Takano S, Kato J, Yamamoto H, et al. Identification of risk factors for lymph node metastasis of colorectal cancer. Hepatogastroenterology, 2007, 54(75): 746-750.
12. Brunner W, Widmann B, Marti L, et al. Predictors for regional lymph node metastasis in T1 rectal cancer: a population-based SEER analysis. Surg Endosc, 2016, 30(10): 4405-4415.
13. Kobayashi H, Mochizuki H, Kato T, et al. Is total mesorectal excision always necessary for T1–T2 lower rectal cancer? Ann Surg Oncol, 2010, 17(4): 973-980.
14. Nash GM, Weiser MR, Guillem JG, et al. Long-term survival after transanal excision of T1 rectal cancer. Dis Colon Rectum, 2009, 52(4): 577-582.
15. Bach SP, Hill J, Monson JR, et al. A predictive model for local recurrence after transanal endoscopic microsurgery for rectal cancer. Br J Surg, 2009, 96(3): 280-290.
16. Greenberg JA, Shibata D, Herndon JE 2nd, et al. Local excision of distal rectal cancer: an update of cancer and leukemia group B 8984. Dis Colon Rectum, 2008, 51(8): 1185-1194.
17. Saraste D, Gunnarsson U, Janson M. Predicting lymph node metastases in early rectal cancer. Eur J Cancer, 2013, 49(5): 1104-1108.
18. Rasheed S, Bowley DM, Aziz O, et al. Can depth of tumour invasion predict lymph node positivity in patients undergoing resection for early rectal cancer? A comparative study between T1 and T2 cancers. Colorectal Dis, 2008, 10(3): 231-238.
19. Lamont JP, McCarty TM, Digan RD, et al. Should locally excised T1 rectal cancer receive adjuvant chemoradiation? Am J Surg, 2000, 180(6): 402-405.
20. Lezoche E, Guerrieri M, Paganini AM, et al. Long-term results in patients with T2-3 N0 distal rectal cancer undergoing radiotherapy before transanal endoscopic microsurgery. Br J Surg, 2005, 92(12): 1546-1552.
21. Wentworth S, Russell GB, Tuner II, et al. Long-term results of local excision with and without chemoradiation for adenocarcinoma of the rectum. Clin Colorectal Cancer, 2005, 4(5): 332-335.
22. Vallam KC, Desouza A, Bal M, et al. Adenocarcinoma of the rectum—A composite of three different subtypes with varying outcomes? Clin Colorectal Cancer, 2016, 15(2): e47-e52.
23. Sung CO, Seo JW, Kim KM, et al. Clinical significance of signet-ring cells in colorectal mucinous adenocarcinoma. Mod Pathol, 2008, 21(12): 1533-1541.
24. Hugen N, van de Velde CJ, de Wilt JH, et al. Metastatic pattern in colorectal cancer is strongly influenced by histological subtype. Ann Oncol, 2014, 25(3): 651-657.
25. Chew MH, Yeo SA, Ng ZP, et al. Critical analysis of mucin and signet ring cell as prognostic factors in an Asian population of 2 764 sporadic colorectal cancers. Int J Colorectal Dis, 2010, 25(10): 1221-1229.
26. Lo DS, Pollett A, Siu LL, et al. Prognostic significance of mesenteric tumor nodules in patients with stage Ⅲ colorectal cancer. Cancer, 2008, 112(1): 50-54.
27. Nagtegaal ID, Quirke P. Colorectal tumour deposits in the mesorectum and pericolon; a critical review. Histopathology, 2007, 51(2): 141-149.
28. Ueno H, Mochizuki H, Hashiguchi Y, et al. Extramural cancer deposits without nodal structure in colorectal cancer: optimal categorization for prognostic staging. Am J Clin Pathol, 2007, 127(2): 287-294.
29. Meyer JE, Cohen SJ, Ruth KJ, et al. Young age increases risk of lymph node positivity in early-stage rectal cancer. J Natl Cancer Inst, 2016, 108(1).
30. Aytac E, Gorgun E, Costedio MM, et al. Impact of tumor location on lymph node metastasis in T1 colorectal cancer. Langenbecks Arch Surg, 2016, 401(5): 627-632.

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Risk factors of lymph node metastasis in T1 rectal cancer

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