Introduction
Several guidelines, including those from the US, Europe, and Japan, recognize "tumor differentiation" as a risk factor for lymph node metastasis (LNM) in T1 colorectal cancer. Surgical resection with lymph node dissection is recommended if poorly differentiated adenocarcinoma, signet-ring cell carcinoma, or mucinous carcinoma are observed in histological findings from endoscopically resected specimens. Recent reports suggest that moderately differentiated adenocarcinoma (tub2) may also be a risk factor for LNM.
Aims & Methods
This study aims to investigate whether tub2 is a risk factor for LNM. We initially evaluated 1,742 patients with T1 colorectal cancer who underwent surgical resection with lymph node dissection at our institution from April 2001 to April 2024. Lesions were assessed based on the worst grade of differentiation. Exclusions were made for patients with (a) metachronous or synchronous advanced cancer, (b) invasion deeper than the muscularis propria, (c) Lynch syndrome, familial adenomatous polyposis, or ulcerative colitis, (d) preoperative chemotherapy or radiotherapy, (e) missing data, or (f) lesions without surgical resection. In addition, after excluding 177 patients with poorly differentiated, mucinous, or signet-ring cell adenocarcinoma, 881 patients were enrolled for analysis. We investigated the sensitivity, specificity, and area under the receiver operating characteristics (ROC) curve of tub2 for predicting LNM, alongside correlations between pathological factors and LNM using multivariate analysis.
Results
LNM was detected in 9.9% (87/881) of patients. The sensitivity, specificity, and area under the ROC curve for tub2 were 78.2%, 42.2%, and 0.60, respectively. In the univariate analysis, tub2 was associated with LNM (p<0.001). Multivariate analysis identified lymphatic invasion, vascular invasion, and tub2 as significant risk factors for LNM, with odds ratios of 7.49, 1.97, and 1.95 (p < 0.01, < 0.01, and = 0.02, respectively).
Conclusion
Moderately differentiated adenocarcinoma (tub2) is a risk factor for LNM in T1 colorectal cancer.
Disclosure
Conflicts of interest:None