Digestive Disease Centre, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.
Br J Surg. 2021 Jul 23;108(7):769-776. doi: 10.1093/bjs/znab168.
National screening programmes increase the proportion of T1 colorectal cancers. Local excision may be possible, but the risk of lymph node metastases (LNMs) could jeopardize long-term outcomes. The aim of the present study was to review the association between histopathological findings and LNMs in T1 colorectal cancer.
A systematic literature search was conducted using PubMed,Embase, and Cochrane online databases. Studies investigating the association between one or more histopathological factors and LNMs in patients who underwent resection for T1 colorectal cancer were included.
Sixteen observational studies were included in the meta-analysis, including a total of 10 181 patients, of whom 1 307 had LNMs. Lymphovascular invasion (odds ratio (OR) 7.42; P < 0.001), tumour budding (OR 4.00; P < 0.001), depth of submucosal invasion, whether measured as at least 1000 µm (OR 3.53; P < 0.001) or Sm2-3 (OR 2.12; P = 0.020), high tumour grade (OR 3.75; P < 0.001), polypoid growth pattern (OR 1.59; P = 0.040), and rectal location of tumour (OR 1.36; P = 0.003) were associated with LNMs.
Distinct histopathological factors associated with nodal metastases in T1 colorectal cancer can aid selection of patients for local excision or major excisional surgery.
国家筛查计划增加了 T1 结直肠癌的比例。局部切除可能是可行的，但淋巴结转移（LNM）的风险可能危及长期预后。本研究旨在回顾 T1 结直肠癌中组织病理学发现与 LNM 之间的关系。
使用 PubMed、Embase 和 Cochrane 在线数据库进行系统文献检索。纳入研究了分析 T1 结直肠癌患者中一个或多个组织病理学因素与 LNM 之间关系的观察性研究。
16 项观察性研究纳入荟萃分析，共纳入 10181 例患者，其中 1307 例发生 LNM。淋巴管侵犯（比值比（OR）7.42；P<0.001）、肿瘤芽（OR 4.00；P<0.001）、黏膜下浸润深度（至少 1000μm 时测量，OR 3.53；P<0.001）或 Sm2-3（OR 2.12；P=0.020）、高肿瘤分级（OR 3.75；P<0.001）、息肉样生长模式（OR 1.59；P=0.040）和肿瘤直肠位置（OR 1.36；P=0.003）与 LNM 相关。
与 T1 结直肠癌淋巴结转移相关的明确组织病理学因素有助于选择局部切除或主要切除手术的患者。
