Classic and Novel Histopathologic Risk Factors for Lymph Node Metastasis in T1 Colorectal Cancer: A Systematic Review
Mark A Dykstra1, Tamara I Gimon2, Paul E Ronksley3
1Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.
Diseases of the Colon and Rectum
|August 16, 2021
Summary
Histopathologic factors like lymphovascular invasion and tumor budding significantly predict lymph node metastasis in T1 colorectal cancers. A depth of 1500 µm was most strongly associated with metastasis, aiding risk stratification.
Area of Science:
- Oncology
- Gastroenterology
- Pathology
Background:
- Treatment for T1 colorectal cancers relies on lymph node metastasis risk assessment.
- Histopathologic features guide risk stratification, but consensus on high-risk indicators is lacking.
Purpose of the Study:
- To systematically review and meta-analyze histopathologic risk factors for lymph node metastasis in T1 colorectal cancers.
Main Methods:
- Searched MEDLINE, Embase, Scopus, and Cochrane databases up to August 2018.
- Included studies with oncologic resection and reported histopathologic risk factors.
- Compared lymph node positivity rates between patients with and without identified risk factors.
Main Results:
- Lymphovascular invasion, vascular invasion, neural invasion, and poorly differentiated histology were significant predictors.
- Tumor budding (OR=4.99) and poorly differentiated clusters (OR=14.61) showed strong associations.
- A depth of 1500 µm (OR=4.37) was the most significant depth-related factor.
Conclusions:
- Identified 1500 µm depth, tumor budding, and poorly differentiated clusters as significant risk factors for metastasis.
- Findings can inform guidelines for T1 tumor risk stratification.
- Further research is needed on the contribution of poorly differentiated clusters to metastasis.
