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Worst Histology-Based Risk Stratification for Lymph Node Metastasis in Patients With T1b Colorectal Cancer: A

Satomi Shibata¹, Shin-Ichiro Horiguchi², Koichi Koizumi¹

¹Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital Tokyo Japan.

|June 8, 2026

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A new worst histology (WH) approach improves risk stratification for lymph node metastasis in T1b colorectal cancer (CRC). This method helps identify low-risk patients, potentially avoiding unnecessary surgeries.

Area of Science:

Oncology
Pathology
Surgical Oncology

Background:

Histological subtype is crucial for risk stratifying lymph node metastasis (LNM) in T1 colorectal cancer (CRC).
Conventional assessment may overlook poorly differentiated components in T1b CRC, impacting accurate risk stratification.
A reproducible worst histology (WH) approach is needed for T1b CRC.

Purpose of the Study:

To develop and validate a T1b-specific risk stratification framework using a reproducible worst histology (WH) approach.
To compare the performance of WH-based methods against dominant histology (DH) and conventional criteria for predicting LNM in T1b CRC.

Main Methods:

Retrospective analysis of 488 patients with pT1b CRC who underwent surgical resection and lymph node dissection.
Histological evaluation using dominant histology (DH), worst histology (WH), and WH focusing on poorly differentiated adenocarcinoma (WH-por).

Keywords:

T1 colorectal cancer lymph node metastasis poorly differentiated adenocarcinoma risk stratification worst histology

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Identification of independent risk factors for LNM for each approach and comparison with Japanese Society for Cancer of the Colon and Rectum (JSCCR) criteria.

Main Results:

The WH-por approach showed better LNM risk identification in T1b colon cancer compared to DH and WH.
The WH approach performed better than WH-por in T1b rectal cancer.
Low-risk subgroup in colon cancer had a 1.7% LNM rate (vs. 4.1% JSCCR); in rectal cancer, it was 8.0% (vs. 8.6% JSCCR).

Conclusions:

A WH-based approach enhances LNM risk stratification in T1b CRC.
This framework aids in identifying selected low-risk patients, supporting individualized treatment decisions.
It may help refine the necessity of additional surgical resection for T1b CRC patients.