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Subpopulation analysis of survival in high-risk T1 colorectal cancer: surgery versus endoscopic resection only

      Background and Aims

      This study aimed to assess the long-term survival of patients with T1 colorectal cancer (CRC) after local or surgical resection considering the type and number of risk factors for lymph node metastasis.

      Methods

      This study included patients with high-risk T1 CRC who underwent therapeutic resection at the National Cancer Center, Korea between January 2001 and December 2014. Risk factors included positive resection margin, high-grade histology, deep submucosal invasion, vascular invasion, budding, and no background adenoma (BGA). We statistically divided the population into favorable or unfavorable subpopulations. The favorable subpopulation included the following 5 combinations of risk factors: positive margin only or unconditional for margin status, deep submucosal invasion only, budding only, no BGA only, and budding + no BGA. We analyzed the survival rate according to the resection type (local or surgical) in the total cohort and in each subpopulation.

      Results

      Eighty-one and 466 patients underwent local and surgical resections, respectively. The distant recurrence-free survival (DRFS) and overall survival (OS) rates were significantly high in the surgical group (hazard ratio [HR], .20; 95% confidence interval [CI], .06-.61; P = .0045 and HR, .41; 95% CI, .25-.70; P = .0010, respectively). In the favorable subpopulation, both DRFS and OS rates were not significantly different between the surgical and local groups (HR, .26; 95% CI, .02-4.19; P = .3431 and HR, .58; 95% CI, .27-1.23; P = .1534, respectively).

      Conclusions

      Intensive surveillance without additional surgery may be another option in selected cases after of high-risk T1 CRC endoscopic resection.

      Abbreviations:

      BGA (background adenoma), CI (confidence interval), CRC (colorectal cancer), CSS (colorectal cancer–specific survival), DRFS (distant recurrence-free survival), HR (hazard ratio), LNM (lymph node metastasis), LR (local resection), OS (overall survival), RFS (recurrence-free survival), SR (surgical resection)
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      References

        • Kobayashi H.
        • Mochizuki H.
        • Morita T.
        • et al.
        Characteristics of recurrence after curative resection for T1 colorectal cancer: Japanese multicenter study.
        J Gastroenterol. 2011; 46: 203-211
        • Berger A.C.
        • Sigurdson E.R.
        • LeVoyer T.
        • et al.
        Colon cancer survival is associated with decreasing ratio of metastatic to examined lymph nodes.
        J Clin Oncol. 2005; 23: 8706-8712
        • Hashiguchi Y.
        • Muro K.
        • Saito Y.
        • et al.
        Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2019 for the treatment of colorectal cancer.
        Int J Clin Oncol. 2020; 25: 1-42
        • Kitajima K.
        • Fujimori T.
        • Fujii S.
        • et al.
        Correlations between lymph node metastasis and depth of submucosal invasion in submucosal invasive colorectal carcinoma: a Japanese collaborative study.
        J Gastroenterol. 2004; 39: 534-543
        • Ueno H.
        • Mochizuki H.
        • Hashiguchi Y.
        • et al.
        Risk factors for an adverse outcome in early invasive colorectal carcinoma.
        Gastroenterology. 2004; 127: 385-394
        • Ha R.K.
        • Han K.S.
        • Sohn D.K.
        • et al.
        Histopathologic risk factors for lymph node metastasis in patients with T1 colorectal cancer.
        Ann Surg Treat Res. 2017; 93: 266-271
        • Han K.S.
        • Lim S.W.
        • Sohn D.K.
        • et al.
        Clinicopathological characteristics of T1 colorectal cancer without background adenoma.
        Colorectal Dis. 2013; 15: e124-e129
        • Asayama N.
        • Oka S.
        • Tanaka S.
        • et al.
        Long-term outcomes after treatment for T1 colorectal carcinoma.
        Int J Colorectal Dis. 2016; 31: 571-578
        • Tamaru Y.
        • Oka S.
        • Tanaka S.
        • et al.
        Long-term outcomes after treatment for T1 colorectal carcinoma: a multicenter retrospective cohort study of Hiroshima GI Endoscopy Research Group.
        J Gastroenterol. 2017; 52: 1169-1179
        • Oh J.R.
        • Park B.
        • Lee S.
        • et al.
        Nomogram development and external validation for predicting the risk of lymph node metastasis in T1 colorectal cancer.
        Cancer Res Treat. 2019; 51: 1275-1284
        • Nam M.J.
        • Han K.S.
        • Kim B.C.
        • et al.
        Long-term outcomes of locally or radically resected T1 colorectal cancer.
        Colorectal Dis. 2016; 18: 852-860
        • Overwater A.
        • Kessels K.
        • Elias S.
        • et al.
        Endoscopic resection of high-risk T1 colorectal carcinoma prior to surgical resection has no adverse effect on long-term outcomes.
        Gut. 2018; 67: 284-290
        • Takamaru H.
        • Saito Y.
        • Sekiguchi M.
        • et al.
        Endoscopic resection before surgery does not affect the recurrence rate in patients with high-risk T1 colorectal cancer.
        Clin Translat Gastroenterol. 2021; 12e00336
      1. The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon: November 30 to December 1, 2002.
        Gastrointest Endosc. 2003; 58: S3-S43
        • Hamilton S.R.
        • Aaltonen L.A.
        World Health Organization classification of tumours: pathology and genetics of tumours of the digestive system.
        IARC Publications, Lyon, France, 2000
        • Kudo S.
        Endoscopic mucosal resection of flat and depressed types of early colorectal cancer.
        Endoscopy. 1993; 25: 455-461
        • Ueno H.
        • Price A.B.
        • Wilkinson K.H.
        • et al.
        A new prognostic staging system for rectal cancer.
        Ann Surg. 2004; 240: 832-839
        • Hassan C.
        • Wysocki P.T.
        • Fuccio L.
        • et al.
        Endoscopic surveillance after surgical or endoscopic resection for colorectal cancer: European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Digestive Oncology (ESDO) guideline.
        Endoscopy. 2019; 51: 266-277
        • Ferlitsch M.
        • Moss A.
        • Hassan C.
        • et al.
        Colorectal polypectomy and endoscopic mucosal resection (EMR): European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline.
        Endoscopy. 2017; 49: 270-297
        • Iida S.
        • Hasegawa H.
        • Okabayashi K.
        • et al.
        Risk factors for postoperative recurrence in patients with pathologically T1 colorectal cancer.
        World J Surg. 2012; 36: 424-430
        • Shin J.W.
        • Han K.S.
        • Hyun J.H.
        • et al.
        Risk of recurrence after endoscopic resection of early colorectal cancer with positive margins.
        Endoscopy. 2018; 50: 241-247
        • Wang H.S.
        • Liang W.Y.
        • Lin T.C.
        • et al.
        Curative resection of T1 colorectal carcinoma: risk of lymph node metastasis and long-term prognosis.
        Dis Colon Rectum. 2005; 48: 1182-1192
        • Argilés G.
        • Tabernero J.
        • Labianca R.
        • et al.
        Localised colon cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up.
        Ann Oncol. 2020; 31: 1291-1305
        • de Neree Tot Babberich M.P.M.
        • Bronzwaer M.E.S.
        • Andriessen J.O.
        • et al.
        Outcomes of surgical resections for benign colon polyps: a systematic review.
        Endoscopy. 2019; 51: 961-972