Refining Risk Criteria May Substantially Reduce Unnecessary Additional Surgeries after Local Resection of T1 Colorectal Cancer
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
3. Variables
4. Results
Description of the Samples, Management, and Outcomes
5. Association with LNM
6. Association with Poor Outcome
7. Discussion
8. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Variable | LNM− | LNM+ | OR (CI 95%) | p |
---|---|---|---|---|
Sex | ||||
| 44 (81.5%) | 10 (18.5%) | ||
| 40 (87%) | 6 (13%) | 0.66 (0.22–1.98) | 0.4587 |
Age (median) | 66 | 59 | 0.92 (0.871–0.99) | 0.024 |
Location | ||||
| 71 (88.7%) | 9 (11.3%) | ||
| 13 (65%) | 7 (35%) | 4.24 (1.34–13.43) | 0.0138 |
Median endoscopically estimated size in mm | 30 | 30 | 1.00 (0.96–1.04) | 0.9333 |
(range) | (6–80) | (10–50) | ||
Median histologically measured size in mm | 18 | 18 | 0.98 (0.93–1.04) | 0.5882 |
(range) | (5–65) | (12–44) | ||
Morphology | ||||
Pedunculated | 6 (85.7%) | 1 (14.3%) | ||
Non-pedunculated | 78 (83.9%) | 15 (16.1%) | -- | 0.8984 |
Lymphovascular invasion | ||||
Absent | 72 (93.5%) | 5 (6.5%) | ||
Present | 12 (52.2%) | 11 (47.8%) | 17.25 (6.09–48.82) | <0.0001 |
Depth of invasion | ||||
<1000 µm | 23 (92%) | 2(8%) | Ref. | |
≥1000 µm | 49 (79%) | 13 (21%) | 3.05 (0.635–14.650) | 0.1635 |
Not evaluable | 12 (92.3%) | 1 (7.7%) | 0.95 (0.07–11.67) | 0.9734 |
Differentiation grade | ||||
| 73 (91.2%) | 7(8.8%) | Ref. | |
| 9 (60%) | 6(40%) | 6.95 (1.91–2 5.29) | 0.0033 |
| 2 (40%) | 3 (60%) | 15.64 (2.22–109.95) | 0.0057 |
| 0 | 0 | -- | -- |
Histologic grade | ||||
G1 or G2 | 82 (86.3%) | 13(13.7%) | Ref. | |
G3 or G4 | 2 (40%) | 3 (60%) | 9.46 (1.44–62.15) | 0.0193 |
TB grade | ||||
1 | 78 (94%) | 5 (6%) | Ref. | |
2 | 4 (44.4%) | 5 (55.6%) | 19.50 (3.95–96.1) | 0.0003 |
3 | 2 (25%) | 6 (75%) | 46.80 (7.44–294.12) | <0.0001 |
PDC | ||||
Absent | 70 (94.6%) | 4 (5.4%) | Ref. | |
Present | 14 (53.8%) | 12 (46.2%) | 15.00 (4.21–53.34) | <0.0001 |
Differentiation grade classified by PDC | ||||
G1 PDC− | 64(95.5%) | 3 (4.5%) | Ref. | -- |
G1 PDC+ | 9 (70%) | 4 (30%) | 9.48 (1.81–40.44) | 0.0076 |
G2 PDC− | 6 (86%) | 1 (14%) | 3.55 (0.31–39.7) | 0.3028 |
G2 PDC+ | 3 (38%) | 5(62%) | 35.55 (5.64–224.10) | 0.0001 |
G3 PDC− | 0 (0%) | 0 (0%) | -- | -- |
G3 PDC+ | 2 (40%) | 3 (60%) | 32.0(3.79–269.59) | 0.0014 |
Muscularis mucosae disruption | ||||
Incomplete | 65 (86.7%) | 10 (13.3%) | Ref. | 0.0667 |
Complete | 13 (68.4%) | 6 (31.6%) | 3.00 (0.92–9.70) | |
Not evaluable | 6 (100%) | 0 (0%) | -- | |
Width of invasion | ||||
<4000 µm | 64(84.2%) | 12 (15.8%) | Ref. | |
≥4000 µm | 5 (64.5%) | 3 (37.5%) | 3.2 (0.67–15.20) | 0.1435 |
Not evaluable | 15 (93.7%) | 1 (6.2%) | 0.35 (0.04–2.95) | 0.3382 |
Intratumoral inflammation | ||||
Absent or mild | 58 (81.7%) | 13 (18.3%) | Ref. | |
Moderate/intense | 26 (89.7%) | 3 (10.3%) | 0.51 (0.13–1.96) | 0.3307 |
Peritumoral inflammation | ||||
Absent or mild | 34 (85%) | 6 (15%) | ||
Moderate/intense | 50 (83.3%) | 10 (16.7%) | 1.13 (0.37–3.41) | 0.8238 |
Background adenoma | ||||
Present | 81 (84.4%) | 15 (15.6%) | Ref. | |
Absent | 3 (75%) | 1 (25%) | 1.80 (0.17–18.48) | 0.6209 |
Macroscopically complete resection | ||||
| 81 (83.3%) | 16(16.7%) | ||
| 3 (100%) | 0 (0%) | -- | -- |
Resection margin | ||||
| 48 (84.2%) | 9 (15.8%) | Ref. | |
| 28 (82.4%) | 6 (17.65) | 1.88 (0.22–16.06) | 0.5638 |
| 8 (88.9%) | 1 (11.1%) | 1.12 (0.06–21.08) | 0.9372 |
En bloc resection | ||||
| 68 (82.9%) | 14 (17.1%) | Ref. | |
| 16 (88.9%) | 2 (11.1%) | 0.56 (0.10–3.12) | 0.511 |
Residual neoplasia after endoscopic resection (in surgical specimen) | ||||
| 41 (83.7%) | 8 (16.3%) | ||
| 2 (100%) | 0 (0%) | -- | -- |
| 41 (83.7%) | 8 (16.3%) |
SE | SP | PPV | NPV | FP | FN | AIC | |
---|---|---|---|---|---|---|---|
TB > 1 + PDC | 68.7 | 92.8 | 54.8 | 95.9 | 45.2 | 4.1 | 64.129 |
PDC alone | 75 | 84.52 | 48 | 94.7 | 52 | 5.3 | 71.012 |
CPRC | 93.75 | 22.72 | 13.3 | 96.6 | 86.7 | 3.4 | -- |
TB > 1 + PDC vs. PDC Alone | TB > 1 + PDC vs. CPRC | PDC Alone vs. CPRC | ||||
---|---|---|---|---|---|---|
FP | 6.8 (−22.1–34.1) | p = 0.67 | 41.5 (17.4–62.8) | p = 0.0001 | 34.7 (14.5–54.1) | p = 0.0002 |
FN | 0.7 (−17.4–7.9) | p = 088 | 1.2 (−6.2–9.7) | p = 0.72 | 1.9 (−16.3–10.03) | p = 0.73 |
Variable | No Poor Outcome | Poor Outcome | OR (CI 95%) | p |
---|---|---|---|---|
Sex | ||||
| 66 (84.6%) | 12 (15.4%) | ||
| 72 (86.7%) | 11 (13.3%) | 1.19 (0.49–2.87) | 0.6995 |
Age (median) | 66 | 59 | 0.92 (0.87–0.99) | 0.024 |
Location | ||||
| 109 (89.3%) | 13 (10.7%) | Ref. | |
| 29 (74.4%) | 10 (25.6%) | 2.891 (1.15–7.25) | 0.0238 |
Median endoscopically estimated size in mm | 30 | 30 | 1.00 (0.97–1.09) | 0.5677 |
(range) | (6–80) | (10–50) | ||
Median histologically measured size in mm | 18 | 16.97 | 0.98 (0.93–1.03) | 0.4327 |
(range) | (5–65) | (7–44) | ||
Morphology | ||||
Pedunculated | 31 (91.2%) | 3 (8.8%) | Ref. | |
Non-pedunculated | 107 (84.3%) | 20 (15.7%) | 0.51 (0.14–1.85) | 0.3126 |
Lymphovascular invasion | ||||
Absent | 127 (93.4%) | 9 (6.6%) | Ref. | |
Present | 11 (44%) | 14 (56%) | 17.95 (6.35–50.79) | <0.0001 |
Depth of invasion | ||||
<1000 µm | 60 (95.2%) | 3 (4.8%) | Ref. | |
≥1000 µm | 64 (79%) | 17 (21%) | 5.31 (1.48–19.04) | 0.0104 |
Not evaluable | 14 (82.4%) | 3 (17.6%) | 4.28 (0.78–23.52) | 0.0939 |
Differentiation grade | ||||
| 120(90.9%) | 12(9.1%) | Ref. | |
| 17 (70.8%) | 7(29.2%) | 4.117 (1.424–11.903) | 0.009 |
| 1(20%) | 4 (80%) | 40 (4.131–387.282) | 0.0014 |
| 0 | 0 | -- | -- |
Histologic grade | ||||
G1 or G2 | 137 (87.8%) | 19(12.2%) | Ref. | |
G3 or G4 | 1 (20%) | 4 (80%) | 28.842 (3.060–271.809) | 0.0033 |
TB grade | ||||
1 | 131 (94%) | 8 (6%) | Ref. | |
>1 | 7 (44.4%) | 15 (55.6%) | 5.923 (3.339–10.508) | <0.0001 |
PDC | ||||
Absent | 120 (93.7%) | 8 (6.3%) | Ref. | |
Present | 18 (54.5%) | 15 (45.5%) | 12.500 (4.640–33.668) | <0.0001 |
Differentiation grade classified by PDC | ||||
G1 PDC− | 109 (94%) | 7 (6%) | Ref. | |
G1 PDC+ | 11 (68.7%) | 5 (31.2%) | 7.07 (1.92–26.08) | 0.0033 |
G2 PDC− | 6 (90.1%) | 1 (9.1%) | 1.55 (0.17–13.95) | 0.6923 |
G2 PDC+ | 7(53.8%) | 5(46.2%) | 13.34 (3.52–50.54) | 0.0001 |
G3 PDC− | 0 (0%) | 0 (0%) | -- | -- |
G3 PDC+ | 1 (20%) | 4(80%) | 62.28 (6.11–634.29) | 0.0005 |
Muscularis mucosae disruption | ||||
Incomplete | 112 (88.2%) | 15 (11.8%) | Ref. | |
Complete | 16 (69.6%) | 7 (30.4%) | 3.26 (1.1559–9.2319) | 0.0255 |
Not evaluable | 10 (90.9%) | 1 (9.1%) | 0.74 (0.09–6.25) | 0.7876 |
Width of invasion | ||||
<4000 µm | 109 (87.9%) | 15 (12.1%) | Ref. | |
≥4000 µm | 6 (54.5%) | 5 (45.5%) | 6.05 (1.64–22.30) | 0.0068 |
Not evaluable | 23 (88.5%) | 3 (11.5%) | 0.94 (0.25–3.54) | 0.9365 |
Intratumoral inflammation | ||||
Absent or mild | 101 (83.5%) | 20 (16.5%) | Ref. | |
Moderate/intense | 36 (92.3%) | 3 (7.7%) | 0.42 (0.12–1.51) | 0.1872 |
Peritumoral inflammation | ||||
Absent or mild | 54 (84.4%) | 10 (15.6%) | Ref. | |
Moderate/intense | 83 (86.5%) | 13 (13.5%) | 1.19(0.49–2.92) | 0.6935 |
Background adenoma | ||||
Present | 135 (86%) | 22 (14%) | ||
Absent | 3 (75%) | 1 (25%) | 0.48 (0.04–4.91) | 0.5433 |
Macroscopically complete resection | ||||
| 127(83.3%) | 23(16.7%) | ||
| 5 (100%) | 0 (0%) | -- | -- |
Resection margin | ||||
| 73 (81.1%) | 17 (8.9%) | Ref. | |
| 50 (92.6%) | 4 (7.4%) | 2.91 (0.92–9.16) | 0.0679 |
| 9 (81.8%) | 2 (8.2%) | 2.77 (0.44–17.48) | 0.2764 |
En bloc resection | ||||
| 110 (85.3%) | 19 (14.7%) | Ref. | |
| 22 (84.6%) | 4 (15.4%) | 1.05 (0.32–3.39) | 0.9316 |
Residual neoplasia after endoscopic resection (in surgical specimen) | ||||
| 95 (86.4%) | 15 (15.6%) | ||
| 2 (100%) | 0 (0%) | -- | -- |
| 41 (83.7%) | 8 (16.3%) |
SE | SP | PPV | NPV | FP | FN | |
---|---|---|---|---|---|---|
LVI + TB > 1 | 65.2 | 94.9 | 61.9 | 95.6 | 38.1 | 4.4 |
CPRC | 95.6 | 40.6 | 16.9 | 98.7 | 83.1 | 1.3 |
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© 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
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Martínez de Juan, F.; Navarro, S.; Machado, I. Refining Risk Criteria May Substantially Reduce Unnecessary Additional Surgeries after Local Resection of T1 Colorectal Cancer. Cancers 2024, 16, 2321. https://doi.org/10.3390/cancers16132321
Martínez de Juan F, Navarro S, Machado I. Refining Risk Criteria May Substantially Reduce Unnecessary Additional Surgeries after Local Resection of T1 Colorectal Cancer. Cancers. 2024; 16(13):2321. https://doi.org/10.3390/cancers16132321
Chicago/Turabian StyleMartínez de Juan, Fernando, Samuel Navarro, and Isidro Machado. 2024. "Refining Risk Criteria May Substantially Reduce Unnecessary Additional Surgeries after Local Resection of T1 Colorectal Cancer" Cancers 16, no. 13: 2321. https://doi.org/10.3390/cancers16132321