[Correlations between risk factors for metastasis in early tumors of the large intestine]

Intramucosal colorectal cancers (Tis) are treated by local excision. Controversies remain as to the management of patients with the submucosally invasive colorectal cancers (EIC). The decision for radical surgery or local excision depends on an estimate of the risk of metastases.

To estimate correlations between the risk factors for metastases in EIC and to evaluate the tests that identify the metastasising EICs. In the study, we investigated the relationships between selected prognostic factors (the gross appearance, depth of submucosal invasion, vessel invasion, grade, presence of adenoma component, and p53 overexpression) and the frequency of metastases in 64 EICs.

Fisher's exact test and log-linear analysis. Tests' evaluation: sensitivity, specificity, predictive values. The metastases were detected in 11 tumours (17%). The metastases were found with the significantly (p < 0.05) higher frequency in moderately differentiated adenocarcinomas, in tumours with massive invasion, with vessel invasion, and with the p53 overexpression. The only interaction was between the grade and the depth of invasion. No other interaction between the risk factors was found with the multivariate analysis. The evaluation of the depth of invasion was characterised by the highest sensitivity in detecting metastases, and by the highest negative predictive value. The highest specificity and the positive predictive value were found for the evaluation of vessel invasion. The massive submucosal invasion, vessel invasion, moderately differentiated characteristics, and the p53 overexpression seem to be the independent risk factors for metastases in EIC. The evaluation of these factors should be helpful as prognostic tests and for the proper choice of the treatment modality for the patients with EIC.