Predicting lymph node metastasis in pT1 colorectal cancer: a systematic review of risk factors providing rationale for therapy decisions
Predicting lymph node metastasis in pT1 colorectal cancer: a systematic review of risk factors providing rationale for therapy decisions
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DOI：
10.1055/s-0033-1344238
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发表时间：
2013-10-01
期刊：
影响因子：
9.3
通讯作者：
Nagtegaal, Iris D.
中科院分区：
文献类型：
--
作者：
Bosch, Steven L.;Teerenstra, Steven;Nagtegaal, Iris D.
背景和研究目的：结直肠癌人群筛查有望增加PT1结直肠癌的数量。局部切除是一种有吸引力的治疗选择，但只有在没有淋巴结转移(LNM)的情况下才是肿瘤安全的。系统地回顾了病理危险因素对PT1结直肠癌淋巴结转移的预测价值，为局部切除后的随访或根治性手术的循证决策提供数据。方法：检索PubMed关于PT1结直肠癌LNM预测因素的报道。以英文发表的包含至少50名患者的论文包括在内。使用Review Manager 5.1进行Meta分析。结果：共纳入17项研究，共涉及3621名有可用结节状态的患者。淋巴侵犯(相对危险度[RR]5.2，95%可信区间[CI]4.0~6.8)、粘膜下侵犯1 mm(RR 5.2，95%CI 1.8~15.4)、芽生(RR 5.1，95%CI 3.6~7.3)和组织分化差(RR 4.8，95%CI 3.3~6.9)是淋巴结转移最强的独立预测因素。这项研究的局限性是：结果不能根据结肠或直肠的位置分层；通过息肉切除而不进行手术切除的非常早期的肿瘤不包括在荟萃分析中；所包括的研究主要来自亚洲国家，因此结果需要在西方人群中进行验证。结论：淋巴管无侵犯、芽生、粘膜下侵犯1 mm、组织分化差均与低风险淋巴结转移有关。整合这些因素的风险分层模型需要进一步研究。
Background and study aim: Population screening for colorectal cancer (CRC) is expected to increase the number of pT1 CRCs. Local excision is an attractive treatment option, but is only oncologically safe in the absence of lymph node metastasis (LNM). A systematic review of the predictive value of pathological risk factors for LNM in pT1 CRC was conducted to provide data for an evidence-based decision regarding follow-up or radical surgery after local excision. Methods: PubMed was searched for reports on predictors of LNM in pT1 CRC. Published papers written in English and containing at least 50 patients were included. Meta-analyses were performed using Review Manager 5.1. Results: A total of 17 studies were included involving a total of 3621 patients with available nodal status. The strongest independent predictors of LNM were lymphatic invasion (relative risk [RR] 5.2, 95 % confidence interval [CI] 4.0 - 6.8), submucosal invasion 1 mm (RR 5.2, 95 %CI 1.8 - 15.4), budding (RR 5.1, 95 %CI 3.6 - 7.3), and poor histological differentiation (RR 4.8, 95 %CI 3.3 - 6.9). Limitations of the study were: results could not be stratified according to location in the colon or rectum; very early tumors removed by polypectomy without surgical resection were not included in the meta-analysis; and included studies were primarily from Asian countries and results therefore need to be verified in Western populations. Conclusion: The absence of lymphatic invasion, budding, submucosal invasion 1 mm, and poor histological differentiation were each associated with low risk of LNM. Risk stratification models integrating these factors need to be investigated further.