Histologic Factors Associated With Need for Surgery in Patients With Pedunculated T1 Colorectal Carcinomas

Area of Science:

• Oncology
• Gastroenterology
• Pathology

Background:

• Pedunculated T1 colorectal tumors often lack lymph node metastases, leading to unnecessary surgeries and complications.
• Accurate identification of patients requiring surgery is crucial to avoid surgical risks.

Purpose of the Study:

• To identify histologic factors associated with the need for surgery in pedunculated T1 colorectal tumors.
• To develop a predictive model for identifying patients who require surgery due to metastasis risk.

Main Methods:

• A cohort-nested matched case-control study involving 708 patients with pedunculated T1 colorectal tumors.
• Analysis of 5 histologic factors using multivariable LASSO regression.
• Comparison with conventional models for risk stratification.

Main Results:

• A LASSO model incorporating lymphovascular invasion, Haggitt level 4, muscularis mucosae disruption, poor differentiation, and tumor budding achieved an AUC of 0.83.
• The model predicted 67.5% of patients did not require surgery, with 83.8% sensitivity and 70.3% specificity for identifying those needing surgery.
• The LASSO model significantly reduced the percentage of patients referred for surgery compared to conventional models.

Conclusions:

• A novel model based on histologic features accurately identifies pedunculated T1 colorectal tumors requiring surgery.
• This model can potentially minimize unnecessary surgeries and guide adjuvant treatment decisions.
• The findings suggest improved risk stratification for early-stage colorectal cancer.